Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

Cancer risk subsequent to cardiovascular disease: a prospective population-based study and meta-analysis

BACKGROUND

Previous preclinical studies have revealed the biological links between cardiovascular diseases (CVD) and cancer. However, population-based evidence remained inconclusive.

METHODS

We assessed cancer incidence among individuals with and without CVD condition in a prospective cohort from the UK Biobank (UKB). Multivariable Cox regression and competing risk models were fitted to estimate hazard ratios (HR). A systematic literature search was conducted in Medline, Embase and Cochrane Library databases to identify published population-based cohort studies (last updated on 1 October 2023) investigating the associations between CVD status and subsequent cancer risk. Random-effects meta-analysis was employed to pool relative effect estimates reported by eligible cohorts. Subgroup and sensitivity analyses were conducted to evaluate the associations across various CVD and cancer subtypes.

RESULTS

For the cohort study in the UKB, after a median follow-up of 11.58 years, a total of 18,471 and 66,891 cancer cases occurred among 94,845 CVD patients and 368,695 non-CVD individuals (Incidence rate: 25.62 vs. 15.41 per 1000 person-years). Individuals with prior CVD exhibited higher overall cancer risk (HR 1.14, 95% CI 1.12-1.17, p < 0.001), and we observed consistently higher cancer risk after adjusting for competing risk from non-cancer deaths. The effect size of CVD on cancer risk was greater among younger individuals (< 65 years) than those ≥ 65 years (p for interaction < 0.001). The meta-analysis included 47 population-based cohort studies where a total of 1.49 million cancer cases were documented among over 45 million participants (9.49 million CVD patients). A 13% higher risk of overall cancer was observed among individuals with prior CVD (pooled RR 1.13, 95% CI 1.11-1.15, p < 0.001). The associations remained significant between various CVD subtypes and cancer risk at multiple sites.

CONCLUSIONS

Our study identified a significantly higher cancer risk among individuals with CVD conditions compared with the non-CVD population, underpinning the need for continued cancer surveillance among CVD patients and further exploration of the possible etiological relation between CVD and cancer.

Global, regional, and national burden of neuroblastoma and peripheral nervous system tumours in individuals aged over 60 from 1990 to 2021: a trend analysis of global burden of disease study

PURPOSE

Elderly individuals diagnosed with neuroblastoma and peripheral nervous system tumours often have a poor prognosis. However, there is currently a lack of comprehensive analysis on these conditions in older adults. This study aims to determine the global epidemiological trends of neuroblastoma and peripheral nervous system tumours (in individuals aged 60 and above).

METHODS

We obtained cross-sectional data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD) ( https://vizhub.healthdata.org/gbd-results/ ). We assessed the burden of neuroblastoma and peripheral nervous system tumours in the elderly from 1990 to 2021 using indicators such as prevalence and incidence. These indicators were classified by global, national, and regional levels, further stratified by Socio-Demographic Index (SDI), age, and gender. The results are organized by SDI, age, and gender categories.

RESULTS

From 1990 to 2021, the global age-standardised prevalence and incidence rates of neuroblastoma and peripheral nervous system tumours among the elderly increased from 0.06 (95% UI 0.05, 0.08) and 0.12 (95% UI 0.09, 0.15) per 100,000 to 0.11 (95% UI 0.09, 0.13) and 0.22 (95% UI 0.17, 0.26) per 100,000, respectively. Age-standardised mortality and DALY rates also rose. Central Europe had the highest age-standardised prevalence and incidence rates in 2021, while Eastern Europe had the highest DALY rate. East Asia reported the highest number of total cases and experienced the fastest growth, with significant increases in prevalence, incidence, mortality, and DALY rates. Gender disparities were evident, with elderly men showing higher rates than women, and greater EAPC values indicating a higher increase in disease burden over time. The highest age-specific rates were found in the 90-94 age group, while the 70-74 age group had the highest DALY burden.

CONCLUSION

The continuous rise in the incidence of neuroblastoma and peripheral nervous system tumours among the elderly highlights a pressing the necessity for focused public health measures and improved treatment approaches. Addressing the regional, gender, and age-related disparities requires a comprehensive approach that integrates medical advancements, social support, and public health policies. Future research should explore potential risk factors and innovative therapies to mitigate this growing global health challenge.

Role of Cardiovascular Health in the Bidirectional Progression Trajectories Between Cardiovascular Disease, Type 2 Diabetes, and Cancer

BACKGROUND

There existed bidirectional associations of cardiovascular disease (CVD) and type 2 diabetes (T2D) with cancer, partly attributed to their shared risk factors. We aimed to explore the role of cardiovascular health (CVH) in bidirectional transitions between CVD, T2D, and cancer.

METHODS

Based on the UK Biobank, we used 2 subcohorts: a disease-free cohort of 277 997 individuals without cancer, CVD, and T2D; and a disease survivor cohort consisting of 61 971 cases with cancer, CVD, and T2D at baseline. The CVH was assessed on the basis of Life's Essential 8 score. We conducted the multistate model and Cox proportional hazards model to explore the role of CVH in bidirectional transitions between CVD, T2D, and cancer in disease-free and disease survivor cohorts, respectively.

RESULTS

High CVH was significantly associated with a lower transition risk from CVD to cancer (hazard ratio, 0.822 [95% CI, 0.693-0.975]). On the other hand, increased CVH was related to reduced risks of progression from cancer to CVD and T2D (both P for trend<0.001), particularly in the high CVH group. For disease survivor cohorts, per 10-point increase in CVH was associated with >10% lower cancer risk in CVD and T2D cases, and a 16% and 42% reduction in the risk of incident CVD and T2D among cancer survivors, respectively.

CONCLUSIONS

High CVH was related to a decreased risk of bidirectional transitions between CVD, T2D, and cancer. This highlighted the significance of maintaining high CVH throughout the life span for the primary prevention of CVD, T2D, and cancer.

Number of chronic diseases and cognitive function among the elderly in China: a moderated mediation model

Purpose

Despite the wealth of data on the role of chronic disease comorbidity in shaping cognitive dysfunction in older adults, a comprehensive view of this dynamic interplay remains a frontier. This study will reveal the intricate interactions between the number of chronic diseases and cognitive function in the elderly, based on the perspective of cognitive function in patients with multiple chronic diseases.

Methods

Our study was based on the data from the 2023 China Psychological Care for the Elderly Action Survey, and the SPSS 26.0 (IBM Corp., Armonk, NY, United States) software package was used for mediation model analysis. The approach encompassed descriptive analysis of variables, Spearman's correlation analyses to explore associations between variables, and a moderated mediation analysis.

Results

The study found that the number of chronic diseases (r = 0.183, p < 0.001) was positively correlated with cognitive function. Anxiety and depression partially mediated the relationship between the number of chronic diseases and cognitive function (β = 0.227, 0.235, both p < 0.001). Age moderated the association between the number of chronic diseases and depression (β = 0.010, p < 0.001).

Conclusion

This study provides a comprehensive mediation model that establishes a new association between the number of chronic diseases and cognitive function in older adults. It suggests that we should pay attention to the negative impact of multiple chronic diseases on cognitive function of the elderly and improve their psychological coping ability, so as to ensure the stable development of healthy aging.

Relationship between LE8 score and peripheral arterial disease from NHANES perspective

Background: This study examined the link between the Life's Essential 8 (LE8) metric and peripheral artery disease (PAD) prevalence in the U.S. Patients and methods: This population-based prospective cohort study analyzed data from 6,076 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. LE8 scores were categorized into low, moderate, and high cardiovascular health (CVH) levels. Multivariable weighted logistic regression and subgroup analyses were performed to examine the relationship between CVH and PAD, adjusting for demographic and clinical variables. Results: In final analysis, a total of 6,076 individuals were included, with a mean age of 59.41±12.80 years and 51.3% (n=3,115) being male. The prevalence of PAD was 6.9% (n=418). After adjusting for confounding factors, compared to participants with low CVH, those with moderate CVH had a 34% lower risk of PAD (OR: 0.66, 95% CI: 0.53-0.82), and those with high CVH had a 62% lower risk of PAD (OR: 0.38, 95% CI: 0.25-0.58). Conclusions: In conclusion, we report that lower CVH scores are associated with higher PAD risk among U.S. adults. These findings may contribute to the prevention strategies for PAD.

Improving our understanding of the longitudinal relationship between health-related quality of life and multimorbidity: The role of personality traits

It is well known that multimorbidity negatively impacts health-related quality of life (HRQoL). However, how psychosocial factors moderate this relationship remains unclear. The present study investigated the moderating effects of personality traits on the relationship between multimorbidity and HRQoL. Data were extracted from three waves (i.e., Waves 13, 17, and 21) of the Household, Income, and Labor Dynamics in Australia (HILDA) survey and a representative cohort of the adult (20+ years) population was followed. The outcomes were three dimensions of SF-36: mental health, physical functioning, and general health. The predictor was the degree of multimorbidity, which was measured by counting the number of self-reported health conditions. The moderator was personality traits measured by the Five-Factor Model (extraversion, emotional stability, agreeableness, openness to experience, and conscientiousness). Mixed-effects models were used to explore the relationship between multimorbidity and HRQoL. Overall, the study cohort comprised 13,285 adults in 2013 who were followed up to 2021, for a total of N = 32,950 observations. There were slightly more (53.9%) females, and the mean (SD) age was 50.3 (16.8) years. Personality traits significantly moderated the relationship between multimorbidity and HRQoL. For instance, extraversion and emotional stability significantly moderated the relationship between multimorbidity and mental health. The moderation effect sizes were larger than established minimal clinically important difference (MCID) thresholds. For example, the impact of 3 health conditions on mental health was moderated from 66 (extraversion score of 4) to 77 (extraversion score of 7), a difference of almost twice the MCID threshold of 6 established for mental health. The results showed that personality traits moderated the relationship between multimorbidity and HRQoL to the extent of potentially influencing clinical decisions. Understanding the influences of personality traits on HRQoL in the context of varying degrees of multimorbidity could enhance interventions for improving quality of life.

Multimorbidity characteristics in older adults and their associated factors in complex networks: a cross-sectional study

Background

Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the older adults in Jiangsu, China is relatively lacking.

Methods

We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patterns in old adults.

Results

The mean age of these patients was 72.0 ± 8.7 years, and the male-to-female ratio was 1: 1.53. These patients during the COVID-19 period (from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases (I10-I15)," "Other forms of heart disease (I30-I52)," "Diabetes mellitus (E10-E14)," "ischaemic heart diseases (I20-I25)" and "Cerebrovascular diseases (I60-I69)." The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by diabetes mellitus, other forms of heart disease, and ischaemic heart diseases (I20-I25).

Conclusion

In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in most periods. However, during the pandemic period, we should pay more attention to diseases that require urgent treatment, such as malignant tumors. For different periods, the spectrum of diseases we focus on should change accordingly.

Association of cardiorespiratory fitness with the incidence and progression trajectory of cardiometabolic multimorbidity

OBJECTIVES

This study examined the relationship of cardiorespiratory fitness (CRF) in the transition from healthy status to first cardiometabolic disease, subsequent cardiometabolic multimorbidity and further to death.

METHODS

We used data from the UK Biobank of 47 484 participants without cardiometabolic diseases at baseline. CRF was assessed via a 6 min incremental ramp cycle ergometer test and expressed in metabolic equivalent of tasks (METs, 1 MET=3.5 mL/kg/min). Cardiometabolic multimorbidity was defined as at least two diseases among diabetes, hypertension, coronary heart disease and stroke.

RESULTS

Over 12.5 years median follow-up, 8123 participants developed first cardiometabolic disease, 1958 developed cardiometabolic multimorbidity and 2177 died. CRF was associated with different transition stages in cardiometabolic multimorbidity development. The HRs (95% CIs) per MET increase in CRF were 0.94 (0.93 to 0.95) and 0.97 (0.96 to 0.99) for transitions from healthy baseline to first cardiometabolic disease and subsequent cardiometabolic multimorbidity. Per MET increase in CRF was associated with reduced risk of transition from healthy baseline to death (HR: 0.97, 95% CI 0.95 to 0.99), but not for the transition from first cardiometabolic disease and cardiometabolic multimorbidity to death. When first cardiometabolic disease was divided into specific cardiometabolic diseases, there were comparable trends of CRF on the disease-specific transitions from healthy baseline to first cardiometabolic disease and subsequent cardiometabolic multimorbidity.

CONCLUSION

Higher CRF was associated with a lower risk of progression from a healthy state to first cardiometabolic disease and subsequently to cardiometabolic multimorbidity. These findings suggest that improving CRF is a potential strategy for preventing cardiometabolic multimorbidity development.

The role of imaging in defining cardiovascular risk to help cancer patient management: a scoping review

OBJECTIVE

This scoping review explores the potential role of cancer-staging chest CT scans in assessing cardiovascular (CV) risk in cancer patients. It aims to evaluate: (1) the correlation between non-gated chest CT and the conventional Agatston score from cardiac CT; (2) the association between coronary calcium scores from non-gated chest CT and CV risk in non-oncological patients; (3) the link between coronary calcium assessed by non-gated chest CT and CV events or endothelial damage in cancer patients.

METHODS

Three different searches were performed on PubMed, according to the three steps described above. Both original articles and systematic reviews were included.

RESULTS

Many studies in the literature have found a strong correlation between coronary calcium scores from non-gated chest CTs and the conventional Agatston scores from gated cardiac CTs. Various methodologies, including Agatston scoring, ordinal scoring, and the "extent" and "length" methods, have been successfully adapted for use with non-gated chest CTs. Studies show that non-gated scans, even those using iodinated contrast, can accurately assess coronary calcification and predict CV risk, with correlations as high as r = 0.94 when compared to cardiac CTs. In oncological settings, studies demonstrated a significant link between coronary calcium levels on non-gated chest CTs and higher CV risk, including MACE and overall mortality.

CONCLUSIONS

Radiological assessment of coronary calcium on non-gated CT scans shows potential for improving CV risk prediction.

CRITICAL RELEVANCE STATEMENT

Non-gated chest CT scans can detect endothelial damage in cancer patients, highlighting the need for standardized radiological practices to assess CV risks during routine oncological follow-up, thereby enhancing radiology's role in comprehensive cancer care.

KEY POINTS

Cancer therapies improve outcomes but increase cardiovascular risk, requiring balanced management. Coronary calcification on non-gated CT correlates with Agatston scores, predicting cardiovascular risk. Routinely performed CTs predict cardiovascular risk, optimizing the management of cancer patients.

The association between healthy lifestyle and multimorbidity of non-communicable chronic diseases trajectory: evidence from a perspective study in UK biobank

BACKGROUND

Although a few studies have found that healthy lifestyle is linked to a range of non-communicable chronic diseases (NCDs), its association with the onset, progression, and prognosis of multimorbidity of NCDs (MNCDs) has never been studied.

METHOD

A total of 332 444 adults aged 39-73 years who were free of heart disease, stroke, diabetes, and cancer at baseline were selected. Then we used multi-state model to analyze the associations between healthy lifestyle and transition trajectory were analyzed with results expressed as hazard ratio (HR) and 95% confidence interval.

RESULTS

A total of 62 994 participants developed first NCDs (FNCDs). After adjustment for potential confounders, healthy lifestyle was negatively associated with the transition trajectory from baseline to FNCD (HR = 0.38), from FNCDs to MNCDs (HR = 0.30), etc. Further, the transition trajectory from FNCDs to MNCDs became more pronounced among the offspring who aged ˂60 (HRFNCDs → MNCDs = 0.29), who never took medicine(HRFNCDs → MNCDs = 0.25). Besides, possessing all five healthy lifestyle factors could extend the life expectancy of MNCD participants.

CONCLUSION

This study suggests that healthy lifestyle is associated with almost all transition phases of MNCDs development and decreases the mortality risk of MNCDs.

Relationship of METS-IR with cardiometabolic multimorbidity in China: a nationwide longitudinal cohort study

Background

Cardiometabolic multimorbidity (CMM) has emerged as a global health challenge with a high mortality risk. This study aimed to explore the association between the metabolic score for insulin resistance (METS-IR) and the incidence of CMM.

Methods

This study included 6,977 individuals in the CHARLS database. We used multiple cox proportional hazards regression and restricted cubic splines (RCS) analysis to evaluate the association between METS-IR and CMM. Subgroup analyses and interaction tests were also performed.

Results

During a median 109 (108-109) months of follow-up, 745 (10.7%) participants were diagnosed with new-onset CMM. The incidences of CMM among participants in quartiles (Q) 1-4 of METS-IR were 4.99, 7.51, 10.67, and 19.54%, respectively. METS-IR was significantly higher in individuals with CMM compared to those without CMM (p < 0.001). After multivariate adjustment, a higher METS-IR was significantly associated with an increased risk of CMM. Compared to participants in Q1 of METS-IR, the hazard ratios (HRs) (95% confidence intervals [CIs]) using cox proportional hazards regression analysis for those in Q2-4 were 1.52 (1.15-2.00), 2.02 (1.56-2.63), and 3.61 (2.80-4.64), respectively. RCS analysis revealed a significant nonlinear association between METS-IR and CMM (nonlinear p < 0.05). The association between METS-IR and the incidence of CMM was present in almost all the subgroups. Furthermore, the predictive ability of METS-IR for CMM was 0.669, which surpassed that of both the triglyceride to high-density lipoprotein cholesterol ratio and the triglyceride glucose index.

Conclusion

A higher METS-IR was closely associated with an increased risk of CMM. Further studies on METS-IR could be beneficial for preventing and treating CMM.

Association between physical activity-related metabolic signature and cardiometabolic diseases and multimorbidity: A cohort study from UK biobank

OBJECTIVE

Physical activity has protective effects on cardiometabolic diseases (CMDs), but the role of metabolism related to physical activity in this process is unclear.

METHODS

In the prospective cohort study from UK Biobank between 2006 and 2022, participants free of CMDs at baseline were included (n = 73,990). We identified physical activity-related metabolites and constructed metabolic signature using linear regression and elastic net regression. Association between physical activity, metabolic signature, and CMDs (type 2 diabetes [T2D], coronary heart disease [CHD], and stroke) were explored using Cox and mediation analyses. Interactions between the metabolic signature and genetic susceptibility (categorized into "low" and "high" based on the median of polygenic risk scores) were assessed by additive hazard models and relative excess risk due to interaction (RERI). Multi-state models evaluated the association between metabolic signature and disease progression.

RESULTS

We found 58 metabolites were related to physical activity, of which 17 were used to construct metabolic signature. The metabolic signature was associated with reduced risk of T2D (HR = 0.13[0.10-0.16]), CHD (HR = 0.40[0.34-0.47]), and stroke (HR = 0.67[0.53-0.86]), and mediated 40.56 % of the association between physical activity and T2D. The metabolic signature exhibited additive interactions with genetic risk for T2D (RERI = 1.57[1.09-2.05]) and CHD (RERI = 0.27[0.05-0.49]). Finally, the metabolic signature was associated with a reduced risk of transition from CMD to CMM (HR = 0.58[0.42-0.81]).

CONCLUSION

Physical activity-related metabolic signature is linked to reduced risks of CMDs and CMM. We once again emphasize the importance of physical activity for CMDs prevention from a metabolic perspective, especially for individuals at high genetic risk.

The association between the ten-year trajectory of multimorbidity and depressive symptoms among the middle-aged and older adults: Results from the China Health and Retirement Longitudinal Study

BACKGROUND

Despite the established link between chronic conditions and depressive symptoms in recent decades, research into the temporal dynamics between multimorbidity and the occurrence of depressive symptoms remains scarce.

METHODS

A total of 15,882 Chinese middle-aged and older adults with 63,246 observations from the China Health and Retirement Longitudinal Study were included in the present study. Depressive symptoms were evaluated using a 10-item CESD scale, with a threshold set at 12 points. Group-based trajectory modeling was used to examine the multimorbidity developmental trajectories. The risk of depressive symptoms was analyzed using mixed effect logistic regression models.

RESULTS

Among the final included 15,896 participants, 37.6 % reported states of multimorbidity, and 25.7 % were detected as depressive symptoms. In the fully adjusted model, those with multimorbidity were 2.36 (2.24 to 2.49) times more likely to present depressive symptoms, and the likelihood increased 1.38 (1.36 to 1.40) times with each additional chronic condition. Four distinct multimorbidity trajectory groups were identified: no-new-condition group (32.6 %), slow growth group (42.9 %), steady growth group (19.7 %), and rapid growth group (4.9 %). Compared to the no-new-condition group, the likelihood of developing depressive symptoms was greater in the subsequent three groups, with ORs of 1.53 (1.39 to1.71), 2.54 (2.24 to 2.89), and 4.40 (3.62 to 5.34), respectively.

CONCLUSION

Our results highlight the substantial health effects of accumulating multimorbidity on depressive symptoms, showing a direct link between risk and accumulation rate. We urge focusing on depressive symptoms in those with multimorbidity to tackle the significant healthcare challenges arising from concurrent physical and mental health issues.

Lifestyle scores and their potential to estimate the risk of multiple non-communicable disease-related endpoints: a systematic review

BACKGROUND

Lifestyle scores have emerged as a practical tool to assess the risk of major non-communicable diseases (NCDs). However, most of them are primarily developed for single NCDs. Given the common risk factors for some of the major NCDs, we conducted a systematic review to evaluate the potential of existing lifestyle scores in predicting the risk of multiple NCD-related endpoints.

METHODS

PubMed, Web of Science, the Cochrane Library, Embase, and Google Scholar were searched from inception to October 2024. We included observational studies assessing the association between lifestyle scores and the risk of morbidity or mortality of multiple NCDs, including type 2 diabetes (T2D), cardiovascular disease (CVD), and cancer.

RESULTS

Of 16,138 unique records identified by the search, 56 eligible studies were included in the systematic review, consisting of 48 cohort studies, 5 case-control studies, 2 case-cohort studies, and 1 cross-sectional study from 16 countries. 15 lifestyle scores were identified to estimate the risk of 32 NCDs, with HLIBMI being the most reported score (14/56, 25.0%). Moderate to strong associations were found between the 15 lifestyle scores and the risk of developing and dying from multiple types of cancers, CVDs, and T2D. Healthy lifestyle scores including additional risk factors (i.e., blood pressure, blood glucose, and waist circumference) aside from major risk factors (i.e., Body Mass Index (BMI), smoking, and diet) seemed to have a stronger ability to estimate NCDs risk than scores including only major risk factors.

CONCLUSION

All 15 simple lifestyle scores were shown to estimate the risk of multiple NCDs endpoints, although some scores were originally developed to estimate the risk of single diseases only. Therefore, further research is required to identify which lifestyle score is most effective for assessing the risk of multiple NCD-related endpoints in a head-to-head comparison.

Combined effect of healthy lifestyles and obesity on cardiometabolic risks in Chinese rural adults

BACKGROUND

Combined effect of healthy lifestyles and obesity on cardiometabolic risks were unclear in Chinese rural adults. We aimed to assess the above-mentioned issue.

METHODS

This study included 25,123 adults from baseline survey of Henan rural cohort study. We collected information regarding current not smoking, current not drinking, healthy diet, adequate exercise, and healthy sleep. We calculated the number of healthy lifestyle factors for each participant or used the latent class analysis to identify clustering classes of healthy lifestyle. Body mass index (BMI), waist circumference (WC), blood pressure, blood lipid, and fasting blood glucose were measured. Logistic models were applied to assess the combined associations of healthy lifestyles and obesity with cardiometabolic risks.

RESULTS

3.8%, 45.8%, and 50.4% of all participants had 0-1, 2-3, and 4-5 healthy factors. The prevalence of obesity defined by BMI and WC was 17.1% and 38.1%, respectively. Compared with participants with obesity who met 0-1 healthy factor, those with obesity who met 4-5 healthy factors have a lower risk of hypertension (odds ratio [OR], 0.41; 95% confidence intervals [95%CI], 0.29-0.58) and dyslipidemia (OR, 0.49; 95%CI, 0.35-0.68) except hyperglycemia (OR, 0.87; 95%CI, 0.53-1.43). Irrespective of the healthy lifestyle scores, compared with participants with normal weight, those with obesity were at higher risk of hypertension, dyslipidemia and hyperglycemia. We obtained similar results when using the latent class analysis or WC to define obesity.

CONCLUSION

Our findings indicated that healthy lifestyle did not entirely offset the obesity-related cardiometabolic risks although it brought some benefits.

Association between air pollution and lifestyle with the risk of developing mild cognitive impairment and dementia in individuals with cardiometabolic diseases

Lifestyle factors and ambient air pollution are linked to dementia and CMDs, yet few studies have investigated their impact on dementia risk in CMDs patients at the same time. The Cox proportional hazards model was used to evaluate the influence of lifestyle and ambient air pollution on the dementia risk of the CMDs population among 438,681 participants in the UK Biobank. It is found that the risk of developing mild cognitive impairment and dementia in the population seems to increase with the increase in the number of CMDs. There appears to be a statistically significant association between high levels of ambient air pollution, unhealthy lifestyles, and a higher risk of developing mild cognitive impairment and dementia in the CMDs population. It is found that a healthy lifestyle may have an effect modifier role in the association between ambient air pollution and the risk of mild cognitive impairment and the development of dementia in patients with CMDs. Therefore, maybe people with CMDs can lessen the impact of ambient air pollution on their risk of developing mild cognitive impairment and dementia by improving their lifestyle.

Atherosclerosis and the Bidirectional Relationship Between Cancer and Cardiovascular Disease: From Bench to Bedside, Part 2 Management

The first part of this review highlighted the evolving landscape of atherosclerosis, noting emerging cardiometabolic risk factors, the growing impact of exposomes, and social determinants of health. The prominent role of atherosclerosis in the bidirectional relationship between cardiovascular disease and cancer was also discussed. In this second part, we examine the complex interplay between multimorbid cardio-oncologic patients, cardiometabolic risk factors, and the harmful environments that lend a "syndemic" nature to these chronic diseases. We summarize management strategies targeting disordered cardiometabolic factors to mitigate cardiovascular disease and explore molecular mechanisms enabling more tailored therapies. Importantly, we emphasize the early interception of atherosclerosis through multifactorial interventions that detect subclinical signs (via biomarkers and imaging) to treat modifiable risk factors and prevent clinical events. A concerted preventive effort-referred to by some as a "preventome"-is essential to reduce the burden of atherosclerosis-driven chronic diseases, shifting from mere chronic disease management to the proactive promotion of "chronic health".

Cardiovascular disease risk in cancer survivors: a population-based cohort study from the UK Biobank, and meta-analysis of cohort studies

Introduction

In addition to the well-recognised cardiotoxicity of cancer treatment, possible aetiological links between cancer diagnosis and cardiovascular disease (CVD) have gained growing research interests. We aimed to estimate the CVD burden among cancer survivors and illustrate population-level associations between these two conditions.

Methods

We first conducted a prospective cohort study in the UK Biobank and a meta-analysis of previous population-based cohorts. HRs were estimated in the cohort study to evaluate the effect of cancer diagnosis on the subsequent risk of CVD compared with that of non-cancer individuals. We then systematically searched Pubmed, Embase and Cochrane Library to retrieve previous cohorts. Random-effect meta-analysis was performed to pool relative risk estimates. A combination of multiple statistical metrics was employed to appraise the evidence.

Results

A total of 39 755 811 participants (5 898 597 cancer survivors vs 33 857 214 cancer-free controls) were identified in our study. In the cohort study, a 51% higher hazard of CVD risk was found among cancer survivors (95% CI 1.48 to 1.55, p<0.001). The hazard decreased to 29% after adjusting competing risk. The meta-analysis identified 104 published cohorts. We found a 1.34-fold increased CVD risk among patients with cancer (95% CI 1.22 to 1.47, p<0.001). The association remains significant among multiple cancer sites and multiple CVD subtypes. This association was consistent, irrespective of chemo or radiotherapy use. Evidence appraisal identified one convincing association between hematologic/lymphatic malignancies and ischaemic heart disease, along with 29 highly suggestive associations.

Conclusions

Our study provided comprehensive estimates of CVD incidence in cancer survivors and identified a significantly elevated CVD risk among patients with cancer, regardless of chemotherapy or radiotherapy. These findings underscore the need for routine assessment of CVD risk factors at cancer diagnosis to enhance the well-being and survival of patients with cancer.PROSPERO registration numberCRD42022307056.

The various associations between whole /regional fat mass and trajectory of cardiometabolic diseases: a nonlinear multistate model

OBJECTIVE

This study aimed to investigate the association of whole body/regional fat mass (FM) with cardiometabolic disease (CMD) trajectory.

METHODS

We conducted a prospective analysis using the UK Biobank. The FM index (FMI), a surrogate for whole body FM, and regional FM (i.e., arm, leg, and trunk) were examined as exposures. A nonlinear multistate framework was used to evaluate the association  between whole/regional FM and CMD trajectory.

RESULTS

Among the 423,966 participants (mean age 56.1 [SD 8.10] years, 43.9% men) with a median follow-up of 13.5 years, varied associations were identified between whole/regional FM and transitions in the CMD trajectory. Upper body FM (i.e., arm and trunk) exhibited significant positive J-shaped associations in the transitions from first CMD (FCMD) or cardiometabolic multimorbidity to death; however, FMI and leg FM demonstrated L-shaped associations. Leg FM played a beneficial role in the transition from FCMD to death, with a hazard ratio of 0.950 (95% CI: 0.931-0.968) per 1 kg.

CONCLUSIONS

Body fat composition and distribution revealed various associations with CMD trajectory, highlighting their clinical importance. Upper body FM among those participants with FCMD or cardiometabolic multimorbidity demonstrated positive J-shaped associations toward death, providing no evidence of the "obesity paradox."

Association Between Blood Urea Nitrogen/Albumin and the Incidence as Well as Progression of Type 2 Diabetes

BACKGROUND

An increased risk of multiple secondary diseases has been observed in individuals with diabetes, which contributes to the growing economic burden. Few studies have established the connection of blood urea nitrogen/albumin (BAR) with diabetes, and its link to subsequent diabetic complications and mortality remains unclear. We aimed to explore the association of BAR with the onset of type 2 diabetes mellitus (T2DM) and its dynamic progression.

METHODS

A total of 20,039 prediabetic participants aged 40-70, without diabetes or related events at baseline, were selected from the UK Biobank. We used a multistate regression model to assess the relationships between BAR and the trajectories of T2DM progression-from pre-T2DM to T2DM, complications, and ultimately mortality. Akaike information criterion (AIC), area under the curve (AUC), and C-statistic analyses were performed to compare the diagnostic performance of BAR with that of HbA1c for assessing T2DM progressions risk.

RESULTS

Over a mean 13-year follow-up, 5621 incident T2DM cases were identified, and among them, 1295 developed diabetes macrovascular complications, 574 developed diabetes microvascular complications, and 1264 died. BAR was significantly associated with the increased risk of T2DM (HR: 1.05, 95% CI: 1.02, 1.09), subsequent macrovascular complications (HR: 1.18, 95% CI: 1.12, 1.25), microvascular complications (HR 1.18, 95% CI: 1.08, 1.28), and further death (HR 1.18, 95% CI: 1.00, 1.39). The ability of BAR (AUC: 0.938, C-statistic: 0.739, p < 0.001) to predict diabetes progression was inferior to that of hemoglobin A1c (HbA1c) (AUC: 0.949, C-statistic: 0.809, p < 0.001).

CONCLUSIONS

Although BAR is significantly positively correlated with the risk of progression at different stages of diabetes, its predictive performance is inferior to that of HbA1c and comparable to that of BUN and albumin. BAR does not demonstrate sufficient clinical significance in predicting diabetes progression, highlighting the need for further investigation.

Association of cardiovascular disease on cancer: observational and mendelian randomization analyses

Extensive research is needed to examine the association between cardiovascular disease (CVD) and cancer. The observational study is based on data collected from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). To assess the connection between CVDs and cancer, we used a weighted multivariable logistic regression analysis with as many confounding factors as feasible included in the model. By employing Mendelian randomization (MR), the unbiased causal relationship between CVDs and cancers was ascertained. The primary analytical approach employed the Inverse Variance Weighted methodology. In cross-sectional study, a positive correlation was observed between CVD and cancer (Model 3, Odds ratio 1.26, 95% confidence interval 1.01 ~ 1.57, p = 0.040). However, MR analysis indicated a negative causal relationship between certain subtypes of CVD and specific cancers, with effect sizes for coronary heart disease and lung cancer (β = - 4.759, p = 0.002), breast cancer (β = - 2.684, p = 0.026), colorectal cancer (β = - 4.581, p = 0.042), liver cancers (β = - 19.264, p = 0.028), and stroke with prostate cancer (β = - 0.299, p = 0.017), with no evidence of a positive correlation. Results from the reverse MR causal analysis revealed a positive correlation between prostate cancer and angina pectoris. An observational study linked CVDs risk to cancer risk. MR analysis has shown that the expected incidence of CVDs can reduce the probability of developing certain forms of cancer. Further investigation is required to examine the clinical correlations and underlying processes between these two illnesses.

Prevalence and determinants of healthy and balanced diet among office workers in a sedentary working environment: evidence from Southern Sri Lanka

BACKGROUND

An unhealthy diet is a key risk factor for non-communicable diseases (NCD), which account for a significant number of premature deaths and disability-adjusted life years worldwide. Office workers are reported to have unhealthy and unbalanced diets, while being sedentary due to the nature of their work, placing them at a greater risk of NCD. This study aimed to determine dietary intake and associated factors among sedentary office workers in Southern Sri Lanka.

METHODS

A cross-sectional study was conducted among 518 sedentary workers in 20 offices in the Galle district. Socio-demographic, health and work-related factors and dietary practices were assessed using a self-administered questionnaire. Twenty-four-hour dietary recall was used to assess dietary intake, which was converted into the number of servings from each food group. Healthy dietary intake was defined as 'adherence to the numbers of servings recommended in Food Based Dietary Guidelines for Sri Lankans for more than three food groups including cereal and cereal-based foods, fruits, and vegetables, with the consumption of one or no unhealthy food per day'.

RESULTS

Only 4.6% (n = 24) of the participants consumed a healthy diet, while a considerable proportion had the recommended intake of cereal-based foods, vegetables and fish, meat and pulses (65.3%, 65.8% and 50.8%, respectively). Intake of fruits, dairy products, nuts and seeds was low among the participants. Meal skipping and group eating were significantly associated with an overall unhealthy diet. Stratified analysis showed sex as an effect modifier for the association between group eating and unhealthy diet. In multivariate analysis, none of the factors showed a significant association with healthy dietary intake.

CONCLUSIONS

The dietary intake of sedentary office workers was not up to the recommendations. Meal skipping and group eating were associated with unhealthy dietary intake. This study recommends introducing interventions to improve the intake of fruits, dairy products, nuts, and seeds for sedentary office workers.

Multisource Data Framework for Prehospital Emergency Triage in Real-Time IoMT-Based Telemedicine Systems

BACKGROUND AND OBJECTIVE

The Internet of Medical Things (IoMT) has revolutionized telemedicine by enabling the remote monitoring and management of patient care. Nevertheless, the process of regeneration presents the difficulty of effectively prioritizing the information of emergency patients in light of the extensive amount of data generated by several integrated health care devices. The main goal of this study is to be improving the procedure of prioritizing emergency patients by implementing the Real-time Triage Optimization Framework (RTOF), an innovative method that utilizes diverse data from the Internet of Medical Things (IoMT).

METHODS

The study's methodology utilized a variety of Internet of Medical Things (IoMT) data, such as sensor data and texts derived from electronic medical records. Tier 1 supplies sensor and textual data, and Tier 3 imports textual data from electronic medical records. We employed our methodologies to handle and examine data from a sample of 100,000 patients afflicted with hypertension and heart disease, employing artificial intelligence algorithms. We utilized five machine-learning algorithms to enhance the accuracy of triage.

RESULTS

The RTOF approach has remarkable efficacy in a simulated telemedicine environment, with a triage accuracy rate of 98%. The Random Forest algorithm exhibited superior performance compared to the other approaches under scrutiny. The performance characteristics attained were an accuracy rate of 98%, a precision rate of 99%, a sensitivity rate of 98%, and a specificity rate of 100%. The findings show a significant improvement compared to the present triage methods.

CONCLUSIONS

The efficiency of RTOF surpasses that of existing triage frameworks, showcasing its significant ability to enhance the quality and efficacy of telemedicine solutions. This work showcases substantial enhancements compared to existing triage approaches, while also providing a scalable approach to tackle hospital congestion and optimize resource allocation in real-time. The results of our study emphasize the capacity of RTOF to mitigate hospital overcrowding, expedite medical intervention, and enable the creation of adaptable telemedicine networks. This study highlights potential avenues for further investigation into the integration of the Internet of Medical Things (IoMT) with machine learning to develop cutting-edge medical technologies.

Influence of impaired glucose tolerance and type 2 diabetes on the multimorbidity cluster of cardiovascular disease and cancer: a post hoc analysis of the Da Qing Diabetes Prevention Outcome Study

BACKGROUND

This study explored the influence of type 2 diabetes and impaired glucose tolerance (IGT) on the risk of the multimorbidity cluster of cardiovascular disease (CVD) and cancer.

METHODS

A total of 1629 participants in the Da Qing Diabetes Prevention Outcome Study were recruited in the present analysis, including normal glucose tolerance (NGT, N = 492), IGT (N = 540), and newly diagnosed type 2 diabetes (N = 597) groups. Cox proportional hazards analyses were performed to assess the relationship between NGT, IGT, and newly diagnosed type 2 diabetes and the risk of the multimorbidity cluster of CVD and cancer.

RESULTS

The incidence rates for multimorbidity cluster CVD and cancer were 1.25, 3.17, and 3.23 per 1000 person-years in people with NGT, IGT, and the newly diagnosed type 2 diabetes groups, respectively, over 34-year follow-up. Cox analysis revealed that diabetes status (as time-dependent variable) was significantly associated with the subsequent increased risk of multimorbidity cluster of CVD and cancer compared with non-diabetes (hazard ratios [HR] = 2.55, 95% confidence interval [CI] 1.51-4.31) after adjustment of potential confounders. Similar analysis showed that this risk was significantly higher in the IGT and newly diagnosed type 2 diabetes groups compared with NGT, with HR of 3.28 (95% CI 1.83-5.87) and HR of 3.90 (95% CI 2.14-7.09), respectively. Whereas compared diabetes with IGT group, this risk was not significantly different.

CONCLUSIONS

Similar to newly diagnosed type 2 diabetes, IGT is significantly associated with an increased risk of the multimorbidity cluster of CVD and cancer compared with NGT. This finding highlights the urgent need for an active detection of IGT and effective prevention and management of diabetes.

Global burden and cross-country inequalities in diseases associated with high body mass index from 1990 to 2019: Result from the Global Burden of Disease Study 2019

Background

High body mass index (BMI) has gradually become an increased risk factor for the global burden of diseases (GBD). As the disease burden and the number of elders globally increase, it is crucial for policymakers to realise the associations between high BMI and disease burden worldwide in a timely manner and to develop effective interventions for different countries and ages.

Methods

We used the GBD 2019 database to analyse the deaths and disability-adjusted life-years (DALYs) in the disease burden associated with high BMI and indicated the health inequality at the global, regional, and national levels. We applied the slope index of inequality and concentration index, two standard metrics of absolute and relative gradient inequality recommended by the World Health Organization (WHO), to quantify the distributive inequalities in the burden of diseases associated with high BMI. These rates were reported per 100 000 population as crude incidence rates, death rates, and DALYs rates. All the estimates were generated with a 95% uncertainty interval (UIs).

Results

Globally, we revealed that an estimated age-standardised mortality rate associated with high BMI is 6.26 million (95% UIs = 3.99, 8.91). The age-standardised DALYs rate is 19.32 million (95% UIs = 12.77, 26.40), and the global population attributable fraction was 9% (95% UIs = 5, 12) in 2019. The largest number of high-BMI-related deaths in women mainly concentrated in the age group of 65-79 years, whereas the largest number in men was in the age group of 60-69 years. The age-standardised DALYs rate of diseases associated with high BMI was larger in the high-middle and middle socio-demographic index (SDI) (population attributable fraction (PAF) = 11 and PAF = 9) regions than those with high SDI (PAF = 1) and low SDI (PAF = 5) regions.

Conclusions

In this study, our results showed that the disease burden of global deaths and DALYs associated with high BMI has substantially increased between 1990-2019. Furthermore, we demonstrated that countries with higher SDI development levels shoulders higher burden of diseases associated with high BMI. Future policies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Joint association of air pollutants on cardiometabolic multimorbidity

We estimated the association between combined exposure to air pollutants and the development of cardiometabolic multimorbidity (CM) and all-cause mortality. An air pollution score was calculated to determine the combined exposure to five air pollutants. CM was defined as the instance of at least two types of diseases. A genetic risk score (GRS) was calculated for each individual. A multistate regression model was used to investigate the effect of the combined associations of air pollutants on each stage of CM progression. After multivariable adjustment, the air pollution score was related with greater susceptibility of CM and all-cause mortality, and those with a high GRS for cardiovascular disease (CVD) or coronary heart disease (CHD) and a high air pollution score had a greater susceptibility of incident CM and all-cause mortality. The multistate model revealed that the greater air pollution score was connected with the susceptibility of progressing from disease-free baseline to having one cardiometabolic disease, and next to CM, and eventually to death. Combined exposure to five air pollutants were related with greater susceptibility of CM and all-cause mortality in a dose-dependent style and is related with the progression of CM and with all-cause mortality.

Bayesian blockwise inference for joint models of longitudinal and multistate data with application to longitudinal multimorbidity analysis

Multistate models provide a useful framework for modelling complex event history data in clinical settings and have recently been extended to the joint modelling framework to appropriately handle endogenous longitudinal covariates, such as repeatedly measured biomarkers, which are informative about health status and disease progression. However, the practical application of such joint models faces considerable computational challenges. Motivated by a longitudinal multimorbidity analysis of large-scale UK health records, we introduce novel Bayesian inference approaches for these models that are capable of handling complex multistate processes and large datasets with straightforward implementation. These approaches decompose the original estimation task into smaller inference blocks, leveraging parallel computing and facilitating flexible model specification and comparison. Using extensive simulation studies, we show that the proposed approaches achieve satisfactory estimation accuracy, with notable gains in computational efficiency compared to the standard Bayesian estimation strategy. We illustrate our approaches by analysing the coevolution of routinely measured systolic blood pressure and the progression of three important chronic conditions, using a large dataset from the Clinical Practice Research Datalink Aurum database. Our analysis reveals distinct and previously lesser-known association structures between systolic blood pressure and different disease transitions.

Outcomes of 1.3 million patients undergoing percutaneous coronary intervention according to the presence of cancer and atrial fibrillation: a retrospective study

AIM

To evaluate outcomes after percutaneous coronary intervention (PCI) in patients with cancer and atrial fibrillation (AF).

METHODS

Data of all adult discharges undergoing PCI between October 2015 and December 2018 were obtained from the National Inpatient Sample (NIS) database. Adjusted odds ratios (aOR) of adverse complications were calculated using binominal logistic regression.

RESULTS

1387320 patients were detected, out of which 15.4% had AF but no cancer, 1.9% had cancer but no AF, and 0.6% had both cancer and AF. Compared with cancer patients without AF, those with AF had a greater aOR of mortality (aOR 1.20, 95%CI 1.08-1.33), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.18, 95%CI 1.07-1.29), and bleeding (aOR 1.23, 95%CI 1.08-1.39). However, the risk of ischemic stroke was similar between the two groups. Patients with solid cancer and AF had a higher aOR for all outcomes, including mortality (aOR 1.28, 95%CI 1.09-1.50), MACCE (aOR 1.37, 95%CI 1.19-1.57), ischemic stroke (aOR 1.48, 95%CI 1.10-1.99), and bleeding (aOR 1.66, 95%CI 1.39-1.98) compared with the solid cancer group without AF. In patients with hematological cancer, AF was associated only with significantly increased risk of mortality (aOR 1.40, 95%CI 1.16-1.70) and MACCE (aOR 1.26, 95%CI 1.06-1.49).

CONCLUSIONS

The presence of AF in solid cancer patients increases the risk of mortality, MACCE, stroke, and major bleeding, while in the setting of hematological cancer it is only associated with a higher risk of mortality and MACCE.

Integrated Cardiorespiratory Rehabilitation and Its Impact on Cardio-Renal-Metabolic Profile After Cardiac Surgery

BACKGROUND

Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are common causes of morbidity and mortality. However, the impact of changes in lifestyle and rehabilitation programs on the progression of cardiovascular, renal, and metabolic (CRM) conditions, remains unclear.

METHODS

In a retrospective manner, we analyzed charts of 200 patients admitted for cardiorespiratory rehabilitation at our facility in 2023. A 6 min walk test, echocardiographic features, and laboratory values were investigated to evaluate the impact of cardiorespiratory rehabilitation in patients post cardiac surgery. This study examined the impact of combined lifestyle and exercise scores (diet, alcohol consumption, smoking, aerobic physical activity, sedentary behavior, sleep duration, and social connection) on cardio-renal-metabolic profiles and on a quality-of-life score measured by the Borg Scale.

RESULTS

During the rehabilitation program, left ventricular ejection fraction (LVEF) significantly increased (51.2 vs. 54.3%, SEM 0.51 p = 0.001). The six-minute walk test (6 MWT) significantly improved in terms of meters (133 vs. 373 m, SEM 6.41, p < 0.001) and Borg scale (6.6 vs. 2.5, SEM 0.06, p < 0.001). Glycemia levels reduced significantly (114.5± vs. 107.4± mg/dL, SEM 2.45, p = 0.001). While total cholesterol levels (119.4 vs. 129.6 mg/dL, SEM 2.4, p < 0.001) as well as HDL levels (29.9 vs. 40 mg/dL, SEM 0.62, p < 0.001) significantly increased, triglyceride levels significantly decreased (128.5 vs. 122.1 mg/dL, SEM 3.8, p = 0.048). There was no change in LDL levels. Creatinine levels remained stable throughout the period of rehabilitation.

CONCLUSIONS

Cardiorespiratory rehabilitation has a significant impact on myocardial function, quality of life in terms of exercise capacity and symptoms (6 MWT) as well as laboratory levels relevant for cardiovascular prevention such as glycemia and lipid profile.

Extreme temperature events, functional dependency, and cardiometabolic multimorbidity: Insights from a national cohort study in China

BACKGROUND

Extreme temperature events (ETEs), including heatwaves and cold spells, are attracting increasing attention because of their impacts on human health. However, the association between ETEs and cardiometabolic multimorbidity (CMM) and the role of functional dependency in this relationship remain unclear.

METHODS

A prospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, considering 12 definitions each for heatwaves and cold spells, and three levels of functional dependency. Mixed Cox models with time-varying variables were used to comprehensively assess the independent and combined effects of ETEs and functional dependency on CMM. Additionally, subgroup analyses were conducted to investigate whether the relationship between ETEs and CMM was modified by the baseline characteristics.

RESULTS

Heatwave and cold spell exposures were associated with an increased risk of CMM (HR range: 1.028-1.102 and 1.046-1.187, respectively). Compared to participants with normal functional abilities, the risk of CMM increased with higher levels of functional dependency (HR range: 1.938-2.185). ETEs exposure and functional dependency are jointly associated with CMM risk. Participants with high-intensity ETEs exposure and high functional dependency had the greatest risk of developing CMM. Participants aged 60 and above were more susceptible to the effects of ETEs on CMM. Additionally, urban residents and those in northern regions were more vulnerable to heatwaves.

CONCLUSION

Both ETEs exposure and functional dependency increase the risk of developing CMM. Participants with functional dependency exposed to high-intensity ETEs faced the highest risk of developing CMM. These findings highlight the significant impact of ETEs on CMM and the importance of protecting vulnerable populations during periods of extreme temperature.

Multimorbidity among the Indigenous population: A systematic review and meta-analysis

BACKGROUND

Multimorbidity, the concurrent presence of multiple chronic health conditions in an individual, represents a mounting public health challenge. Chronic illnesses are prevalent in the Indigenous populations, which contributes to multimorbidity. However, the epidemiology of multimorbidity in this population is not well studied. This review aimed to elucidate the extent, determinants, consequences, and prevention of multimorbidity within Indigenous populations globally, contrasting findings with non-Indigenous populations.

METHODS

Adhering to the PRISMA guidelines, this systematic review assimilated peer-reviewed articles and grey literature, focusing on the prevalence, determinants, implications, and preventive strategies of multimorbidity in global Indigenous populations. Emphasis was given to original, English-language, full-text articles, excluding editorials, and conference abstracts.

FINDINGS

Of the 444 articles identified, 13 met the inclusion criteria. Five studies are from Australia, and the rest are from the USA, Canada, New Zealand, and India. The study indicated a higher multimorbidity prevalence among Indigenous populations, with consistent disparities observed across various age groups. Particularly, Indigenous individuals exhibited a 2-times higher likelihood of multimorbidity compared to non-Indigenous populations. Noteworthy findings underscored the elevated severity of certain comorbid conditions, especially strokes, within Indigenous groups, with further revelations highlighting their significant pairing with conditions such as heart diseases and diabetes.

INTERPRETATION

The findings affirm the elevated burden of multimorbidity among Indigenous populations. Prevalence and risk of developing multimorbidity are significantly higher in this population compared to their non-Indigenous counterparts. Future research should prioritize harmonized research methodologies, fostering insights into the multimorbidity landscape, and promoting strategies to address health disparities in Indigenous populations.

Sarcopenic obesity is associated with cardiometabolic multimorbidity in Chinese middle-aged and older adults: a cross-sectional and longitudinal study

OBJECTIVES

Sarcopenic obesity (SO) has been found to increase the risk of metabolic disorders, however, its relationship with cardiometabolic multimorbidity (CMM) remains unexplored. This study aims to investigate the potential association between SO and CMM in the middle-aged and older population.

METHODS

Our study subjects were from CHARLS. SO was defined as the combination of impaired grip strength (grip strength <28 kg for men and <18 kg for women) and increased body mass index (BMI ≥25 kg/m2). CMM was defined as having two or more cardiometabolic diseases, including diabetes mellitus, stroke, and heart disease. The participants were divided into four groups according to their sarcopenia and obesity status, and logistic regression analysis was used to examine the association between SO and CMM.

RESULTS

A total of 15,252 study subjects were included in the cross-sectional study, with an average age of 60.6 years and a male proportion of 47.4%. In the cross-sectional analysis conducted in 2015, the prevalence of CMM was highest in the SO group (9.1%), followed by the obesity (3.7%) and sarcopenia (3.5%) group. After adjustment for confounding factors, SO [OR (95%CI): 2.453 (1.742-3.455)], sarcopenia [OR (95% CI): 1.601 (1.157-2.217)], obesity [OR (95% CI): 1.446 (1.107-1.888)] were all observed to be associated with CMM, with the strongest association in the SO group. Furthermore, in the longitudinal analysis, only the SO group demonstrated a significant risk for developing CMM [OR (95% CI): 2.302 (1.239-4.228)].

CONCLUSIONS

SO was independently and positively associated with CMM in middle-aged and older population.

Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021

Background

Obesity represents a major global health challenge with important clinical implications. Despite its recognized importance, the global disease burden attributable to high body mass index (BMI) remains less well understood.

Methods

We systematically analyzed global deaths and disability-adjusted life years (DALYs) attributable to high BMI using the methodology and analytical approaches of the Global Burden of Disease Study (GBD) 2021. High BMI was defined as a BMI over 25 kg/m2 for individuals aged ≥20 years. The Socio-Demographic Index (SDI) was used as a composite measure to assess the level of socio-economic development across different regions. Subgroup analyses considered age, sex, year, geographical location, and SDI.

Findings

From 1990 to 2021, the global deaths and DALYs attributable to high BMI increased more than 2.5-fold for females and males. However, the age-standardized death rates remained stable for females and increased by 15.0% for males. Similarly, the age-standardized DALY rates increased by 21.7% for females and 31.2% for males. In 2021, the six leading causes of high BMI-attributable DALYs were diabetes mellitus, ischemic heart disease, hypertensive heart disease, chronic kidney disease, low back pain and stroke. From 1990 to 2021, low-middle SDI countries exhibited the highest annual percentage changes in age-standardized DALY rates, whereas high SDI countries showed the lowest.

Interpretation

The worldwide health burden attributable to high BMI has grown significantly between 1990 and 2021. The increasing global rates of high BMI and the associated disease burden highlight the urgent need for regular surveillance and monitoring of BMI.

Funding

National Natural Science Foundation of China and National Key R&D Program of China.

Modern Instrumental Methods of Diagnostics and Risk Assessment of Developing Antitumor Therapy Cardiovasculotoxicity

The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.

Investigating the impact of extreme weather events and related indicators on cardiometabolic multimorbidity

BACKGROUND

The impact of weather on human health has been proven, but the impact of extreme weather events on cardiometabolic multimorbidity (CMM) needs to be urgently explored.

OBJECTIVES

Investigating the impact of extreme temperature, relative humidity (RH), and laboratory testing parameters at admission on adverse events in CMM hospitalizations.

DESIGNS

Time-stratified case-crossover design.

METHODS

A distributional lag nonlinear model with a time-stratified case-crossover design was used to explore the nonlinear lagged association between environmental factors and CMM. Subsequently, unbalanced data were processed by 1:2 propensity score matching (PSM) and conditional logistic regression was employed to analyze the association between laboratory indicators and unplanned readmissions for CMM. Finally, the previously identified environmental factors and relevant laboratory indicators were incorporated into different machine learning models to predict the risk of unplanned readmission for CMM.

RESULTS

There are nonlinear associations and hysteresis effects between temperature, RH and hospital admissions for a variety of CMM. In addition, the risk of admission is higher under low temperature and high RH conditions with the addition of particulate matter (PM, PM2.5 and PM10) and O3_8h. The risk is greater for females and adults aged 65 and older. Compared with first quartile (Q1), the fourth quartile (Q4) had a higher association between serum calcium (HR = 1.3632, 95% CI: 1.0732 ~ 1.7334), serum creatinine (HR = 1.7987, 95% CI: 1.3528 ~ 2.3958), fasting plasma glucose (HR = 1.2579, 95% CI: 1.0839 ~ 1.4770), aspartate aminotransferase/ alanine aminotransferase ratio (HR = 2.3131, 95% CI: 1.9844 ~ 2.6418), alanine aminotransferase (HR = 1.7687, 95% CI: 1.2388 ~ 2.2986), and gamma-glutamyltransferase (HR = 1.4951, 95% CI: 1.2551 ~ 1.7351) were independently and positively associated with unplanned readmission for CMM. However, serum total bilirubin and High-Density Lipoprotein (HDL) showed negative correlations. After incorporating environmental factors and their lagged terms, eXtreme Gradient Boosting (XGBoost) demonstrated a more prominent predictive performance for unplanned readmission of CMM patients, with an average area under the receiver operating characteristic curve (AUC) of 0.767 (95% CI:0.7486 ~ 0.7854).

CONCLUSIONS

Extreme cold or wet weather is linked to worsened adverse health effects in female patients with CMM and in individuals aged 65 years and older. Moreover, meteorologic factors and environmental pollutants may elevate the likelihood of unplanned readmissions for CMM.

The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis

BACKGROUND

Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity.

OBJECTIVE

This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity.

METHODS

Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

RESULTS

The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024.

CONCLUSIONS

This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=512554.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58296.

Transition between cardiometabolic conditions and body weight among women: which paths increase the risk of diabetes and cardiovascular diseases?

Previous studies investigated the association of body weight and hypertension with risk of incident cardiometabolic multimorbidity. Our aim was to estimate the risk of diabetes and cardiovascular disease later in life for subjects with different progression patterns of overweight, obesity, and hypertension in mid-life. This was a prospective cohort study in which data from 12,784 participants in the Australian Longitudinal Study on Women's Health were used. Multistate model was used to study the progression pattern of overweight, obesity, hypertension, diabetes, and cardiovascular disease over the life course. The cumulative incidence of diabetes and cardiovascular disease up to the age of 73 was estimated for women with different patterns of other conditions. The six most common paths and corresponding cumulative incidences for diabetes were overweight 5.1%, obesity 11.5%, hypertension 6.9%, progression from overweight to obesity 8.2%, overweight and hypertension 12.1%, and obesity and hypertension 36.8%. For women with diabetes and other conditions, the cumulative incidence of cardiovascular disease (heart disease or stroke) as the next immediate condition was 22.4%. The corresponding figure for women who only had a report of diabetes but did not have high body weight or hypertension was 8.3%. The higher risk of transition from healthy state to a cardiometabolic condition was associated with low education, income stress, smoking, not drinking alcohol (compared to low drinkers), physical inactivity, and high perceived stress. Women with obesity and hypertension in middle-age had a substantially higher risk of developing diabetes and cardiovascular disease than women without these potentially preventable conditions.

Lifestyle factors and their relative contributions to longitudinal progression of cardio-renal-metabolic multimorbidity: a prospective cohort study

BACKGROUND

The role of lifestyle factors and their relative contributions to the development and mortality of cardio-renal-metabolic multimorbidity (CRMM) remains unclear.

METHODS

A study was conducted with 357,554 UK Biobank participants. CRMM was defined as the coexistence of two or three cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD). The prospective study examined the associations of individual and combined lifestyle scores (diet, alcohol consumption, smoking, physical activity, sedentary behavior, sleep duration and social connection) with longitudinal progression from healthy to first cardio-renal-metabolic disease (FCRMD), then to CRMM, and ultimately to death, using a multistate model. Subsequently, quantile G-computation was employed to assess the relative contribution of each lifestyle factor.

RESULTS

During a median follow-up of 13.62 years, lifestyle played crucial role in all transitions from healthy to FCRMD, then to CRMM, and ultimately to death. The hazard ratios (95% CIs) per score increase were 0.91 (0.90, 0.91) and 0.90 (0.89, 0.91) for healthy to FCRMD, and for FCRMD to CRMM, and 0.84 (0.83, 0.86), 0.87 (0.86, 0.89), and 0.90 (0.88, 0.93) for mortality risk from healthy, FCRMD, and CRMM, respectively. Among the seven factors, smoking status contributed to high proportions for the whole disease progression, accounting for 19.88-38.10%. High-risk diet contributed the largest proportion to the risk of transition from FCRMD to CRMM, with 22.53%. Less-frequent social connection contributed the largest proportion to the risk of transition from FCRMD to death, with 28.81%. When we further consider the disease-specific transitions, we find that lifestyle scores had slightly stronger associations with development to T2D than to CVD or CKD.

CONCLUSIONS

Our study indicates that a healthy lifestyle may have a protective effect throughout the longitudinal progression of CRMM, informing more effective management and treatment. Smoking status, diet, and social connection played pivotal roles in specific disease transitions.

Association of cigarette smoking, smoking cessation with the risk of cardiometabolic multimorbidity in the UK Biobank

BACKGROUND

To investigate the association between cigarette smoking, smoking cessation and the trajectory of cardiometabolic multimorbidity (CMM), and further to examine the association of age at smoking initiation and smoking cessation with CMM.

METHODS

This study included 298,984 UK Biobank participants without cardiometabolic diseases (CMDs) (including type 2 diabetes, coronary heart diseases, stroke, and hypertension) at baseline. Smoking status was categorized into former, current, and never smokers, with age at smoking initiation and smoking cessation as a proxy for current and former smokers. The multi-state model was performed to evaluate the association between cigarette smoking, smoking cessation and CMM.

RESULTS

During a median follow-up of 13.2 years, 59,193 participants developed first cardiometabolic disease (FCMD), 14,090 further developed CMM, and 16,487 died. Compared to former smokers, current smokers had higher risk at all transitions, with hazard ratio (95% confidence interval) = 1.59 (1.55 ∼ 1.63) vs. 1.18 (1.16 ∼ 1.21) (P = 1.48 × 10- 118) from health to FCMD, 1.40 (1.33 ∼ 1.47) vs. 1.09 (1.05 ∼ 1.14) (P = 1.50 × 10- 18) from FCMD to CMM, and 2.87 (2.72 ∼ 3.03) vs. 1.38 (1.32 ∼ 1.45) (P < 0.001) from health, 2.16 (1.98 ∼ 2.35) vs. 1.25 (1.16 ∼ 1.34) (P = 1.18 × 10- 46) from FCMD, 2.02 (1.79 ∼ 2.28) vs. 1.22 (1.09 ∼ 1.35) (P = 3.93 × 10- 17) from CMM to death; whereas quitting smoking reduced the risk attributed to cigarette smoking by approximately 76.5% across all transitions. Reduced risks of smoking cessation were also identified when age at quitting smoking was used as a proxy for former smokers.

CONCLUSIONS

Cigarette smoking was associated with a higher risk of CMM across all transitions; however, smoking cessation, especially before the age of 35, was associated with a significant decrease in CMM risk attributed to cigarette smoking.

Interaction between Extreme Temperature Events and Fine Particulate Matter on Cardiometabolic Multimorbidity: Evidence from Four National Cohort Studies

Accumulating evidence linked extreme temperature events (ETEs) and fine particulate matter (PM2.5) to cardiometabolic multimorbidity (CMM); however, it remained unknown if and how ETEs and PM2.5 interact to trigger CMM occurrence. Merging four Chinese national cohorts with 64,140 free-CMM adults, we provided strong evidence among ETEs, PM2.5 exposure, and CMM occurrence. Performing Cox hazards regression models along with additive interaction analyses, we found that the hazards ratio (HRs) of CMM occurrence associated with heatwave and cold spell were 1.006-1.019 and 1.063-1.091, respectively. Each 10 μg/m3 increment of PM2.5 concentration was associated with 17.9% (95% confidence interval: 13.9-22.0%) increased risk of CMM. Similar adverse effects were also found among PM2.5 constituents of nitrate, organic matter, sulfate, ammonium, and black carbon. We observed a synergetic interaction of heatwave and PM2.5 pollution on CMM occurrence with relative excess risk due to the interaction of 0.999 (0.663-1.334). Our study provides novel evidence that both ETEs and PM2.5 exposure were positively associated with CMM occurrence, and the heatwave interacts synergistically with PM2.5 to trigger CMM.

On the use of the healthy lifestyle index to investigate specific disease outcomes

The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell's C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

Association between changes in cardiovascular health and the risk of multimorbidity: community-based cohort studies in the UK and Finland

Background

Better cardiovascular health is associated with lower risk of various chronic diseases, but its association with multimorbidity is poorly understood. We aimed to examine whether change in cardiovascular health is associated with multimorbidity risk.

Methods

The primary analysis was conducted in the Whitehall II multiwave prospective cohort study (UK) and the validation analysis in the Finnish Public Sector cohort study (Finland). Change in cardiovascular health was assessed using the American Heart Association Life's Simple 7 (LS7) and Life's Essential 8 (LE8) at baseline and re-assessments, using objective measures in Whitehall II and self-reports and pharmacy claims in the Finnish Public Sector cohort study, respectively. Multimorbidity was defined as the presence of two or more of 12 chronic diseases during follow-up. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox's proportional hazard models with age as time scale, adjusting for sex, education, occupation, marital status, and ethnicity.

Findings

In the primary analysis among 9715 participants, mean age was 44.8 (standard deviation 6.0) years and 67.6% participants were men at baseline. During the median follow-up of 31.4 (interquartile range 26.8-32.3) years, 2751 participants developed multimorbidity. The hazard of multimorbidity decreased by 8% (HR 0.92, 95% CI 0.88-0.96) per ideal LS7 metric increment over 5 years and by 14% (HR 0.86, 95% CI 0.80-0.93) per ten points increase in LE8 score over 10 years. These findings were replicated in the validation analysis among 75,377 participants in terms of 4-year change in cardiovascular health.

Interpretation

Improvement in cardiovascular health was associated with lower multimorbidity risk in two community-based cohort studies. Interventions improving cardiovascular health of the community may contribute to multimorbidity prevention.

Funding

None.

Effects of the Omaha System- and HeartScore®-Based Impaired-Risk Perception Reduction Program on the Risk Perception of Individuals Aged 50-65 Years: A One-Group Pre-Test-Post-Test Study

PURPOSE

This study evaluates the impact of interventions in the Omaha System and HeartScore®-based program to reduce impaired-risk perception.

DESIGN

and setting: This study utilized a one-group pre-test-post-test design.

SUBJECTS

The program was conducted among participants aged over 50 years from different social settings.

INTERVENTION

The program had three parts: a briefing on HeartScore® recommendations, Omaha System interventions, and referral to a doctor.

MEASURES

HeartScore® determined cardiovascular disease (CVD) risk, body mass index (BMI) was calculated from height and weight, and the International PA Questionnaire evaluated physical activity (PA) levels. Self-assessment was used to perceived CVD risk, BMI, and PA.

ANALYSIS

We used the Wilcoxon signed-rank test to compare the pre-test and post-test scores of the Omaha System, the problem rating scale (PRS) subscales and McNemar test to measure changes in CVD risk perception, BMI, and PA level.

RESULTS

310 high-risk individuals out of 522 had impaired perception of their CVD risk. Only 201 responded to follow-up phone calls. Interventions based on HeartScore® and Omaha System improved CVD risk and PA perceptions (P < .001) but not BMI. The program significantly increased knowledge, status, and behavior scores (P < .001). After participating, 39% saw a cardiologist, and 57.2% saw a family physician within six months to reduce impaired risk perception. CVD risk perception increased to the actual level after the intervention, mostly in the group with low education level.

CONCLUSIONS

The program using the Omaha System and HeartScore® can help middle-aged individuals better understand their risk of cardiovascular disease.

Mechanistic Association of Hepatoblastoma with Cerebral Palsy: A Narrative Review

Hepatoblastoma is a rare liver cancer that occurs most often in children who present with lower birth weight. Cerebral palsy (CP) is a neurodevelopmental disorder distinguished by irregularities in muscle tone, movement, and motor skills. CP is caused by damage to the developing brain and is often associated with secondary complications such as severe constipation. Clinicians must be aware of sudden worsening constipation occurring in CP children because it can also be a sign of hepatoblastoma. The aim of this review is to summarize the current understanding of the risks for hepatoblastoma development in children with CP. Cancer risks likely include dysfunction of the immune system surveillance in CP children. Elevated C-reactive protein and tumor necrosis factor-alpha levels may be higher in children with CP, which weakens their innate immune system. Metabolic disruption increases the risk of some cancers, and poor nutrition and reduced growth that occur in CP patients may have an impact on cancer development through a loss in immune function. Increased mobility and physical activity can increase the T-cell, natural killer cell, and neutrophil population. Children with CP tend to engage poorly in physical activity, and consequently, their immune system is affected. There are multiple factors associated with CP that increase the risk of childhood cancers such as hepatoblastoma.

Metformin use correlated with lower risk of cardiometabolic diseases and related mortality among US cancer survivors: evidence from a nationally representative cohort study

BACKGROUND

In the USA, the prolonged effective survival of cancer population has brought significant attention to the rising risk of cardiometabolic morbidity and mortality in this population. This heightened risk underscores the urgent need for research into effective pharmacological interventions for cancer survivors. Notably, metformin, a well-known metabolic regulator with pleiotropic effects, has shown protective effects against cardiometabolic disorders in diabetic individuals. Despite these promising indications, evidence supporting its efficacy in improving cardiometabolic outcomes in cancer survivors remains scarce.

METHODS

A prospective cohort was established using a nationally representative sample of cancer survivors enrolled in the US National Health and Nutrition Examination Survey (NHANES), spanning 2003 to 2018. Outcomes were derived from patient interviews, physical examinations, and public-access linked mortality archives up to 2019. The Oxidative Balance Score was utilized to assess participants' levels of oxidative stress. To evaluate the correlations between metformin use and the risk of cardiometabolic diseases and related mortality, survival analysis of cardiometabolic mortality was performed by Cox proportional hazards model, and cross-sectional analysis of cardiometabolic diseases outcomes was performed using logistic regression models. Interaction analyses were conducted to explore the specific pharmacological mechanism of metformin.

RESULTS

Among 3995 cancer survivors (weighted population, 21,671,061, weighted mean [SE] age, 62.62 [0.33] years; 2119 [53.04%] females; 2727 [68.26%] Non-Hispanic White individuals), 448 reported metformin usage. During the follow-up period of up to 17 years (median, 6.42 years), there were 1233 recorded deaths, including 481 deaths from cardiometabolic causes. Multivariable models indicated that metformin use was associated with a lower risk of all-cause (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.47-0.81) and cardiometabolic (HR, 0.65; 95% CI, 0.44-0.97) mortality compared with metformin nonusers. Metformin use was also correlated with a lower risk of total cardiovascular disease (odds ratio [OR], 0.41; 95% CI, 0.28-0.59), stroke (OR, 0.44; 95% CI, 0.26-0.74), hypertension (OR, 0.27; 95% CI, 0.14-0.52), and coronary heart disease (OR, 0.41; 95% CI, 0.21-0.78). The observed inverse associations were consistent across subgroup analyses in four specific cancer populations identified as cardiometabolic high-risk groups. Interaction analyses suggested that metformin use as compared to non-use may counter-balance oxidative stress.

CONCLUSIONS

In this cohort study involving a nationally representative population of US cancer survivors, metformin use was significantly correlated with a lower risk of cardiometabolic diseases, all-cause mortality, and cardiometabolic mortality.

Association of lifestyles and multimorbidity with mortality among individuals aged 60 years or older: Two prospective cohort studies

Lifestyles are associated with all-cause mortality, yet limited research has explored the association in the elderly population with multimorbidity. We aim to investigate the impact of adopting a healthy lifestyle on reducing the risk of all-cause mortality in older individuals with or without multimorbidity in both China and UK. This prospective study included 29,451 and 173,503 older adults aged 60 and over from Chinese Longitudinal Healthy Longevity Survey (CLHLS) and UK Biobank. Lifestyles and multimorbidity were categorized into three groups, respectively. Cox proportional hazards regression was used to estimate the Hazard Ratios (HRs), 95% confidence intervals (95% CIs), and dose-response for all-cause mortality in relation to lifestyles and multimorbidity, as well as the combination of both factors. During a mean follow-up period of 4.7 years in CLHLS and 12.14 years in UK Biobank, we observed 21,540 and 20,720 deaths, respectively. For participants with two or more conditions, compared to those with an unhealthy lifestyle, adopting a healthy lifestyle was associated with a 27%-41% and 22%-42% reduction in mortality risk in the CLHLS and UK Biobank, respectively; Similarly, for individuals without multimorbidity, this reduction ranged from 18% to 41%. Among participants with multimorbidity, individuals with an unhealthy lifestyle had a higher mortality risk compared to those maintaining a healthy lifestyle, with HRs of 1.15 (95% CI: 1.00, 1.32) and 1.27 (95% CI: 1.16, 1.39) for two conditions, and 1.24 (95% CI: 1.06, 1.45) and 1.73 (95% CI: 1.56, 1.91) for three or more conditions in CLHLS and UK Biobank, respectively. Adherence to a healthy lifestyle can yield comparable mortality benefits for older individuals, regardless of their multimorbidity status. Furthermore, maintaining a healthy lifestyle can alleviate the mortality risks linked to a higher number of diseases.

Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort

BACKGROUND

Healthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality.

METHODS

Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35-70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and ranged from 0 to 16 units. A change score was calculated as the difference between HLI at baseline and follow-up. Associations between HLI change and all-cause and cancer mortality were modelled with Cox regression, and the impact of changing HLI on accelerating mortality rate was estimated by rate advancement periods (RAP, in years).

RESULTS

After the follow-up questionnaire, participants were followed for an average of 9.9 years, with 21,696 deaths (8407 cancer deaths) documented. Compared to participants whose HLIs remained stable (within one unit), improving HLI by more than one unit was inversely associated with all-cause and cancer mortality (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.81, 0.88; and HR: 0.87; 95% CI: 0.82, 0.92; respectively), while worsening HLI by more than one unit was associated with an increase in mortality (all-cause mortality HR: 1.26; 95% CI: 1.20, 1.33; cancer mortality HR: 1.19; 95% CI: 1.09, 1.29). Participants who worsened HLI by more than one advanced their risk of death by 1.62 (1.44, 1.96) years, while participants who improved HLI by the same amount delayed their risk of death by 1.19 (0.65, 2.32) years, compared to those with stable HLI.

CONCLUSIONS

Making healthier lifestyle changes during adulthood was inversely associated with all-cause and cancer mortality and delayed risk of death. Conversely, making unhealthier lifestyle changes was positively associated with mortality and an accelerated risk of death.

Diabetes and Cancer: A Twisted Bond

This paper presents an overview of the interconnection between various factors related to both cancer and type 2 diabetes mellitus (T2DM). Hyperglycemia, hyperinsulinemia, chronic inflammation, and obesity are involved in the development and progression of both diseases but, strong evidence for a direct causal relationship between diabetes and cancer, is lacking. Several studies described a relationship between hyperglycemia and cancer at the cellular, tissular and organismic levels but at the same time recent Mendelian randomization studies proved a significant causal relationship only between hyperglycemia and breast cancer. On the other hand, the association between both hyperinsulinemia and obesity and several cancer types appears to be robust as demonstrated by Mendelian randomized studies. Metabolic alterations, including the Warburg effect and excessive glucose consumption by tumors, are discussed, highlighting the potential impact of dietary restrictions, such as fasting and low-carb diets, on tumor growth and inflammation. Recent data indicates that circulating branched-chain amino acids levels, may represent novel biomarkers that may contribute to both better diabetes control and early pancreatic cancer detection. Understanding the underlying mechanisms and shared risk factors between cancer and T2DM can provide valuable insights for cancer prevention, early detection, and management strategies.

Editorial

Multimorbidity, the existence of two or more concurrent chronic conditions in a single individual, represents a major global health challenge. The Nutrition Society's 2023 Winter Conference at the Royal Society, London focused on the topic of 'Diet and lifestyle strategies for prevention and management of multimorbidity', with symposia designed to explore pathways for prevention of multimorbidity across the lifecourse, the role of ageing, the gut-brain-heart connection and lifestyle strategies for prevention and management of multimorbidity. It also considered machine learning and precision nutrition approaches for addressing research challenges in multimorbidity. The opening plenary lecture discussed advancing diet and lifestyle research to address the increasing burden and complexity of multimorbidity. The two-day programme concluded with a plenary which addressed the key dietary risk factors and policies in multimorbidity prevention.