Association Between Blood Lead Level With High Blood Pressure in US (NHANES 1999–2018)

Leukocyte Telomere Length Mediates the Associations between Blood Lead and Cadmium with Hypertension among Adults in the United States: A Cross-Sectional Study

There is evidence to support the links between lead and cadmium exposure with hypertension and also with leukocyte telomere length (LTL). The objective of this study is to investigate the role that LTL may play in the relationship between lead and cadmium exposure and hypertension. This study consisted of 3718 participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Logistic regression was used to analyze the relationship between blood metals with hypertension, and the mediating model was used to evaluate the mediating effect of LTL. In the fully adjusted model, both blood lead and cadmium ln-transformed concentrations were significantly positively associated with hypertension risk, as were all quartiles of blood lead. Additionally, we observed positive linear dose-response relationships with hypertension by restricted cubic spline analysis (both p overall < 0.001, p non-linear = 0.3008 for lead and p non-linear = 0.7611 for cadmium). The ln-transformed blood lead and cadmium concentrations were associated with shorter LTL. LTL was inversely related to hypertension and the OR was 0.65 (95% CI: 0.47 to 0.89). Furthermore, LTL had mediating effects on the associations of blood lead and cadmium with hypertension risk, and the mediation proportions were 2.25% and 4.20%, respectively. Our findings suggested that exposure to lead and cadmium raised the risk of hypertension, while LTL played as a mediating factor.

Estimated Pulse Wave Velocity Predicts All-Cause and Cardiovascular-Cause Mortality in Individuals With Hypertension - Findings From a National Health and Nutrition Examination Study 1999-2018

BACKGROUND

This study aimed to investigate the association between estimated pulse wave velocity (ePWV) and mortality outcomes among individuals with hypertension.Methods and Results: Based on the National Health and Nutrition Examination Survey (NHANES) 1999-2018, a total of 14,396 eligible participants with hypertension were enrolled. The ePWV was calculated using the equation based on blood pressure and age. The mortality outcomes of included participants were directly acquired from the National Death Index database. The multivariable Cox regression analysis was used to examine the relationship between ePWV and mortality outcomes. Moreover, the restricted cubic spline (RCS) was also used to explore this relationship. Receiver operating characteristics curves (ROC) were adopted to evaluate the prognostic ability of ePWV for predicting mortality outcomes of patients with hypertension. The median follow-up duration was 10.8 years; individuals with higher an ePWV had higher risks of mortality from both all causes (HR: 2.79, 95% CI: 2.43-3.20) and cardiovascular diseases (HR: 3.41, 95% CI: 2.50-4.64). After adjusting for confounding factors, each 1 m/s increase in ePWV was associated with a 43% increase in all-cause mortality risk (HR: 1.43, 95% CI: 1.37-1.48) and a 54% increase in cardiovascular mortality risk (HR: 1.54, 95% CI: 1.43-1.66).

CONCLUSIONS

This study indicates that ePWV is a novel prognostic indicator for predicting the risks of mortality among patients with hypertension.

Associations of five blood heavy metals with hepatitis B virus infection and immunity in adults: a cross-sectional study

BACKGROUND

Heavy metal pollution has emerged as a significant concern for human health, prompting increased awareness of its potential adverse effects. While previous research has established a connection between heavy metals and liver function biomarkers, the specific relationship between heavy metals and HBV infection remains unexplored. This cross-sectional study aims to investigate the potential correlations between five blood heavy metals - lead, cadmium, mercury, manganese, and selenium - and the presence of HBsAg, HBsAb, and HBcAb in adults.

METHODS

The study utilized data from NHANES 2007-2018. Participants were classified into four groups based on their infectious status, and the association between heavy metals and HBV infection was analyzed using multiple logistic regression and stratification analysis.

RESULTS

A total of 8431 participants were included, with 5 436 classified as Susceptible, 1 765 as Vaccinated, 865 as Natural Infection, and 103 as Acute/Chronic HBV Infection. The Vaccinated group exhibited a lower mean age (34.52 ± 14.16 years) compared to the other groups. Statistically significant differences in heavy metal concentrations (except selenium) were observed among the groups (P < 0.001). After adjusting for covariates, lead was significantly associated with HBV infection (Q2: OR 2.37, 95%CI 1.04-5.39; Q3: OR 2.34, 95%CI 1.01-5.40), and positive trends were observed for high blood concentrations of mercury (Q4: OR 3.03, 95%CI 1.31-7.04) and manganese (Q4: OR 2.52, 95%CI 1.20-5.28). Furtherly, the presence of lead reduced the protection of HBsAb (Q2: OR 0.84, 95%CI 0.73-0.97; Q3: OR 0.77, 95%CI 0.66-0.90; Q4: OR 0.83, 95%CI 0.70-0.98). Subgroup analysis indicated that cadmium was associated with an increased risk of HBV infection in Asians (OR 1.36, 95%CI 1.03-1.78) and individuals with a BMI range of 25 to 30 (OR 1.60, 95%CI 1.17-2.18).

CONCLUSIONS

The study's findings suggest a correlation between elevated blood Pb concentrations and reduced immunization rates against hepatitis B. Individuals with a positive HBsAg exhibit lower blood Se concentrations and higher blood Hg and Mn concentrations.

Enhancing digital health services: A machine learning approach to personalized exercise goal setting

Background

The utilization of digital health has increased recently, and these services provide extensive guidance to encourage users to exercise frequently by setting daily exercise goals to promote a healthy lifestyle. These comprehensive guides evolved from the consideration of various personalized behavioral factors. Nevertheless, existing approaches frequently neglect the users' dynamic behavior and the changing in their health conditions.

Objective

This study aims to fill this gap by developing a machine learning algorithm that dynamically updates auto-suggestion exercise goals using retrospective data and realistic behavior trajectory.

Methods

We conducted a methodological study by designing a deep reinforcement learning algorithm to evaluate exercise performance, considering fitness-fatigue effects. The deep reinforcement learning algorithm combines deep learning techniques to analyze time series data and infer user's exercise behavior. In addition, we use the asynchronous advantage actor-critic algorithm for reinforcement learning to determine the optimal exercise intensity through exploration and exploitation. The personalized exercise data and biometric data used in this study were collected from publicly available datasets, encompassing walking, sports logs, and running.

Results

In our study, we conducted the statistical analyses/inferential tests to compare the effectiveness of machine learning approach in exercise goal setting across different exercise goal-setting strategies. The 95% confidence intervals demonstrated the robustness of these findings, emphasizing the superior outcomes of the machine learning approach.

Conclusions

Our study demonstrates the adaptability of machine learning algorithm to users' exercise preferences and behaviors in exercise goal setting, emphasizing the substantial influence of goal design on service effectiveness.

Correlation between serum iron levels and pulmonary function: A cross-sectional analysis based on NHANES database 5319 cases

Pulmonary function, one of the main indicators of respiratory system assessment, is difficult to measure in specific cases. The study investigated the association between serum iron levels and pulmonary function. The cross-sectional study was conducted using data from 5319 participants from the 2010-2012 National Health and Nutrition Examination Survey. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow from 25% to 75% of FVC were used as indicators of pulmonary function to analyze the relationship of serum iron and pulmonary function. Univariate and stratified analyses, multiple equation regression analysis, smoothed curve fitting analysis, and threshold effect analysis were performed to explore the relationship between pulmonary function and serum iron concentrations. Threshold effect analysis revealed a nonlinear relationship between serum iron levels and FVC, as well as FEV1, with inflection points observed at 8.1 (µmol/L) and 8.4 (µmol/L), respectively. When serum iron concentrations fell below the inflection point, there was no statistically significant relationship between serum iron and FVC (P = .065) or FEV1 (P = .095) (P > .005). However, when serum iron concentrations exceeded the inflection point, both FVC (β = 6.87; 95% confidence interval [CI] = 3.95, 9.79; P < .0001) and FEV1 (β = 7.09; 95% CI = 4.54, 9.64; P < .0001) exhibited a positive correlation with increasing serum iron levels. Additionally, forced expiratory flow from 25% to 75% of FVC (mL/s) demonstrated a positive association with serum iron (β = 6.72; 95% CI = 2.30, 11.13; P = .0029). Serum iron level was positively correlated with pulmonary function within a certain range of serum iron concentration. Serum iron level may be a protective factor for pulmonary function.

Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms

Lead poisoning, often associated with occupational exposure, can also arise from intake of traditional and herbal medicines with high lead content. Geriatric patients displaying gastrointestinal symptoms from such sources are frequently misdiagnosed. An individual in his 70s reported to our geriatric clinic with vomiting, constipation and anaemia. A meticulous history unveiled his recent intake of herbal remedies. Heavy metal assay indicated elevated lead levels in his blood and urine, consistent with the high lead content we measured in the herbal medication. Following supportive treatment, nutritional supplementation and chelation therapy with calcium disodium EDTA, he improved. Follow-up tests indicated a decrease in lead levels and resolution of anaemia. This case emphasises the importance of considering lead poisoning as a potential diagnosis in patients with unexplained symptoms, particularly when there is a history of herbal or alternative medication intake. Timely recognition and appropriate management can lead to better outcome.

Association between blood selenium with parkinson's disease in the US (NHANES 2011-2020)

Selenium is an essential trace element for human health, playing a key role in regulating cellular oxidative stress, immune response, and inflammation. In recent years, the association between selenium and Parkinson's disease (PD) has aroused people's attention. The objective of this study is to investigate the relationship between blood selenium concentrations and PD risk in a sample of U.S. adults. A cross-sectional study was conducted using the National Health and Nutrition Examination Survey (NHANES) data from 2011-2020 and included 15,660 adults aged over 40 years old. Univariate logistic regression and multivariate logistic regression models were utilized to analyze the association between blood selenium concentrations and PD prevalence. Additionally, the restricted cubic spline (RCS) model was applied to investigate the dose-response relationships between blood selenium and PD. The findings indicated a link between elevated blood selenium levels and a reduced occurrence of Parkinson's disease (PD). Notably, this association between blood selenium and PD exhibited a non-linear pattern, wherein the decline in PD risk was more pronounced at higher selenium concentrations than at lower levels. An inflection point emerged at approximately 2.4 μmol/L, beyond which the rate of decline in risk significantly diminished with increasing selenium levels. A potential association between blood selenium concentrations and PD has been observed, with PD patients having lower blood selenium levels compared to non-PD patients. Higher levels of blood selenium may have a protective effect against PD. However, further prospective studies are needed to investigate the effect of blood selenium in PD patients and to determine causality.

Association of remnant cholesterol with hypertension, type 2 diabetes, and their coexistence: the mediating role of inflammation-related indicators

PURPOSE

Cholesterol metabolism is a risk factor for cardiovascular disease, and recent studies have shown that cholesterol metabolism poses a residual risk of cardiovascular disease even when conventional lipid risk factors are in the optimal range. The association between remnant cholesterol (RC) and cardiovascular disease has been demonstrated; however, its association with hypertension, type 2 diabetes mellitus (T2DM), and the concomitance of the two diseases requires further study. This study aimed to evaluate the association of RC with hypertension, T2DM, and both in a large sample of the U.S. population, and to further explore the potential mechanisms involved.

METHODS

This cross-sectional study used data from the 2005-2018 cycles of the National Health and Nutrition Examination Survey (N = 17,749). Univariable and multivariable logistic regression analyses were performed to explore the relationships of RC with hypertension, T2DM, and both comorbidities. A restricted cubic spline regression model was used to reveal the dose effect. Mediation analyses were performed to explore the potential mediating roles of inflammation-related indicators in these associations.

RESULTS

Of the 17,749 participants included (mean [SD] age: 41.57 [0.23] years; women: 8983 (50.6%), men: 8766 (49.4%)), the prevalence of hypertension, T2DM, and their co-occurrence was 32.6%, 16.1%, and 11.0%, respectively. Higher RC concentrations were associated with an increased risk of hypertension, T2DM, and their co-occurrence (adjusted odds ratios for per unit increase in RC were 1.068, 2.259, and 2.362, and 95% confidence intervals were 1.063-1.073, 1.797-2.838, and 1.834-3.041, respectively), with a linear dose-response relationship. Even when conventional lipids were present at normal levels, positive associations were observed. Inflammation-related indicators (leukocytes, lymphocytes, monocytes, and neutrophils) partially mediated these associations. Among these, leukocytes had the greatest mediating effect (10.8%, 14.5%, and 14.0%, respectively).

CONCLUSION

The results of this study provide evidence that RC is associated with the risk of hypertension, T2DM, and their co-occurrence, possibly mediated by an inflammatory response.

Serum levels of lead are associated with venous thromboembolism: a retrospective study based on the NHANES database (1999 to 2018)

Background

Venous thromboembolism (VTE) is a common clinical problem. While lead toxicity is known to affect the nervous, hematopoietic system, skeletal, and cardiovascular system, the relationship between blood lead levels and VTE remains unclear. This study explored whether there is a correlation between the levels of serum lead and VTE through a retrospective analysis based on data from the National Health and Nutrition Examination Survey (NHANES), so as to provide a reference for follow-up research and clinical practice.

Methods

According to the inclusion and exclusion criteria, subjects were enrolled from the NHANES (1999 to 2018) database and divided into a VTE group and a non-VTE group. The factors related to VTE were analyzed by single factor and multiple factor logistic regression analysis.

Results

A total of 31,081 subjects were included, of which 59 had VTE (0.19%). The higher the levels of serum lead, the higher the incidence of VTE. The univariate analysis revealed that age, male sex, history of cigarette use, hypertension, diabetes, and serum lead levels were factors associated with VTE in the population from the NHANES database. Further multivariate analysis revealed that age, history of cigarette use, hypertension, diabetes, and serum lead levels were factors associated with VTE.

Conclusions

The findings of this study suggest that higher serum levels of lead may be associated with VTE.

Association of different obesity patterns with hypertension in US male adults: a cross-sectional study

Obesity is an important risk factor for hypertension. We aimed to investigate the association between different obesity patterns and hypertension risk in a large male population in the US. Male participants from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) were enrolled in this cross-sectional study. Social demographic information, lifestyle factors, anthropometric measurements and biochemical measurements were collected. Three obesity patterns were classified according to the body mass index (BMI) and waist circumference (WC), including overweight and general obesity, abdominal obesity, and compound obesity. We adopted multivariate logistic regression to investigate the associations between hypertension and different obesity patterns after adjusting for cofounding factors. Subgroup analysis, stratified by age, smoking, drinking and estimated glomerular filtration rate (eGFR), was also conducted to explore the associations between obesity patterns and hypertension risk among different populations. Moreover, the association between WC and hypertension among male individuals was also explored using restricted cubic spline (RCS) analysis. Receiver operating characteristic (ROC) was used to evaluate the discriminatory power of WC for screening hypertension risk. 13,859 male participants from NHANES survey (2007-2018) were enrolled. Comparing with the normal-weight group, the odds ratios (ORs) [95% confidence interval (CI)] for hypertension in individuals with overweight and general obesity, abdominal obesity and compound obesity were 1.41 [1.17-1.70], 1.97 [1.53-2.54] and 3.28 [2.70-3.99], respectively. Subgroup analysis showed that the effect of different obesity patterns on hypertension risk was highly stable among individuals with different clinical conditions. In addition, WC had a positive correlation with the risk of hypertension (OR: 1.43; 95% CI 1.37-1.52; P < 0.001) in fully adjusted multivariate logistic regression model. RCS analysis showed that the association between WC and hypertension risk was in a nonlinear pattern, and WC had a good discriminatory power for hypertension in ROC analysis. Different patterns of obesity have a great impact on the risk of hypertension among male individuals. Increment of WC significantly increased the hypertension risk. More attention should be paid to the prevention of obesity, especially abdominal obesity and compound obesity in male individuals.

Relationship between Serum Selenium Level and Self-Reported History of Kidney Stone

A relationship may exist between selenium and kidney calculi, but there is a lack of research in this field at present. Our study explored the relationship between the serum selenium level and a medical history of adult kidney calculi. We utilized data from the National Health and Nutrition Examination Survey conducted between 2011 and 2016. Participants self-reported their history of kidney stones, while serum selenium levels were measured using inductively coupled plasma dynamic reaction cell mass spectrometry. Our findings indicate a negative correlation between serum selenium levels and the risk of kidney stone history. In the multiple-adjusted model, the lowest serum selenium level group had a higher risk than the other groups. The odds ratio (95% confidence interval) of ever having kidney stones for the highest serum selenium level group was 0.54 (0.33-0.88). In the results of stratified analysis, this relationship was still significant in the groups of women and those 40-59 years. We also found that as a nonlinear dose-response relationship between serum selenium levels and the history of kidney stones disease. In our research, we found that people with higher serum selenium levels had a lower risk of having a history of kidney stones. We concluded that selenium may have a protective effect on kidney stones. In the future, more population studies are needed to explore the relationship between selenium and kidney stones.

The association of lead exposure with blood pressure and hypertension: a mediation analyses of estimated glomerular filtration rate

The link between lead and blood pressure was debatable, and whether it was mediated by renal function was unknown. The purpose was to investigate the relationship between blood lead concentrations and blood pressure and hypertension, as well as the mediating role of estimated glomerular filtration rate (eGFR) in this relationship. Participants aged 18 were recruited from the National Health and Nutrition Examination Survey (1999-2014) and provided with lead and blood pressure data. Multivariate linear and logistic regression, stratification, interaction tests, and a restricted cubic spline curve were used to assess the association of blood lead with systolic/diastolic blood pressure (SBP/DBP) and hypertension, and mediation effect analysis was used to investigate the role of eGFR in this relationship. A total of 20,073 subjects were enrolled, and among them, 9837 (49.01%) were male and 7800 (38.86%) were hypertensive patients. Multivariate linear and logistic regression analysis showed that blood lead levels were significantly associated with SBP (β = 3.14, 95%CI: 2.03, 4.25; P < 0.001), DBP (β = 3.50, 95%CI: 2.69, 4.30; P < 0.001), and hypertension (OR = 1.29, 95%CI: 1.09, 1.52; P = 0.0026). In comparison to the lowest blood lead quartile, the highest lead group was significantly associated with SBP (= 2.55, 95%CI: 1.66, 3.44; P = 0.0001), DBP (= 2.60, 95%CI: 1.95, 3.24; P = 0.0001), and hypertension (OR = 1.26, 95%CI: 1.10, 1.45; P = 0.0007). Mediation analysis showed that the proportion of blood lead mediated for SBP, DBP, and hypertension was 3.56% (95%CI: 0.42%, 7.96%; P = 0.0320), 6.21% (95%CI: 4.02%, 9.32%; P < 0.0001), and 17.39% (95%CI: 9.34%, 42.71%; P < 0.0001), respectively. Adjusted restricted cubic spline curves presented a non-linear correlation of blood lead levels with DBP (P-non-linearity < 0.001), linear with SBP (P-non-linearity = 0.203), and hypertension (P-non-linearity = 0.763). Our findings demonstrated that blood lead levels were non-linear with DBP, but linear with SBP and hypertension, and this relationship was mediated by eGFR.

Associations between novel anthropometric measures and the prevalence of hypertension among 45,853 adults: A cross-sectional study

AIMS

Traditional anthropometric measures, including body mass index (BMI), are insufficient for evaluating the risk of hypertension. We aimed to investigate the association between novel anthropometric indices and hypertension risk in a large population in the United States.

METHODS

Forty-five thousand eight hundred fifty-three participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were enrolled. Social demographic information, lifestyle factors, blood biochemical measurements and anthropometric indices, including body weight, body mass index (BMI), waist circumference, waist-to-height ratio (WtHR), conicity index (CI), a body shape index (ABSI), body roundness index (BRI) and lipid accumulation product (LAP) were collected. Multivariable logistic regression and restricted cubic spline were adopted to investigate the associations between hypertension risk and anthropometric indices. We also performed receiver operating characteristic (ROC) curve analyses to further evaluate the discriminatory powers of anthropometric measurements for screening hypertension risk. Moreover, participants were randomly assigned to the training group and the validation group in a ratio of 3 to 1. A nomogram model based on anthropometric measures was established and validated in the training group and validation group, respectively.

RESULTS

All of the anthropometric measurements investigated were positively and independently associated with the hypertension risk. Among all anthropometric indices, per-SD increment in ABSI had the highest OR (OR: 3.4; 95% CI: 2.73-4.24) after adjusting for age, sex, race/ethnicity, education, smoking, drinking, diabetes, and eGFR. Moreover, results from restricted cubic splines revealed the non-linear association between anthropometric measurements and hypertension risk. In ROC analyses, CI had superior discriminatory power for hypertension (area under the curve: 0.71; 95% CI: 0.706-0.715; optimal cutoff value: 1.3) compared with other indices. Nomogram model based on age, sex, diabetes, CI and LAP showed favorable predicting ability of hypertension risk with an AUC (95% CI) in training group of 80.2% (79.7-80.6%), and the AUC (95% CI) in validation group was 79.5% (78.3-80.1%). Meanwhile, calibration plot showed good consistency.

CONCLUSIONS

Anthropometric measurements including BMI, WtHR, CI, ABSI, BRI and LAP are closely associated with hypertension risk in the present study. For better prevention and treatment of hypertension, more attention should be paid to anthropometric indices, especially novel anthropometric indices.

Association between blood lead levels and hyperlipidemiais: Results from the NHANES (1999-2018)

Background

Research on the association between blood lead (Pb) and lipid biomarkers have yielded inconsistent results, and epidemiological studies on blood Pb levels and hyperlipidemia are scarce. The present study aimed to examine the association between blood Pb levels and hyperlipidemia in adults from the National Health and Nutrition Examination Survey (NHANES).

Methods

A total of 43,196 participants in the NHANES from 1999 to 2018 were included in the final analysis. Hyperlipidemia was determined based on the National Cholesterol Education Program guidelines. Blood Pb levels were assessed using inductively-coupled plasma mass spectrometry. Weighted multivariable logistic regression analysis and subgroup analysis were conducted to determine the correlation between blood Pb levels and hyperlipidemia.

Results

In the multivariable logistic regression model, high blood Pb levels were significantly associated with hyperlipidemia after adjusting for confounders (OR 1.41; 95%CI: 1.18-1.67). Furthermore, elevated blood Pb levels were associated with an increased risk of hyperlipidemia across the four quartile (Q) groups (Q1: OR 1.00; Q2: OR 1.16 [95%CI: 1.04-1.29]; Q3: OR 1.39 [95%CI: 1.21-1.59]; and Q4: OR 1.33 [95%CI: 1.15-1.54]; P for trend <0.05). Significant moderating effects were found in the subgroup analysis stratified by age, education, hypertension, and diabetes (P < 0.05). In sensitivity analysis, the ORs for hyperlipidemia across the quartiles of blood Pb levels were 1.00, 1.17 (95%CI: 1.05-1.30), 1.42 (95%CI: 1.24-1.62), and 1.38 (95%CI: 1.19-1.60) for Q1, Q2, Q3, and Q4, respectively (P for trend <0.001) after removing adults with arteriosclerotic cardiovascular disease, and the ORs were 1.00, 1.13 (95%CI: 1.01-1.25), 1.38 (95%CI: 1.21-1.56), and 1.32 (95%CI: 1.16-1.52) for Q1, Q2, Q3, and Q4, respectively (P for trend <0.001) after including pregnant women.

Conclusion

The current study showed a positive association between blood lead levels and hyperlipidemia.