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BACKGROUND: The morbidity and mortality of heart disease are increasing in middle-aged and elderly people in China. It is necessary to explore relationships and interactive associations between heart disease and its risk factors in order to prevent heart disease. OBJECTIVE: To establish a Bayesian network model of heart disease and its influencing factors in middle-aged and elderly people in China, and explore the applicability of the elite-based structure learner using genetic algorithm based on ensemble learning (EN-ESL-GA) algorithm in etiology analysis and disease prediction. METHODS: Based on the 2013 national tracking survey data from China Health and Retirement Longitudinal Study (CHARLS) database, EN-ESL-GA algorithm was used to learn the Bayesian network structure. Then we input the data and the learned network structure into the Netica software for parameter learning and inference analysis. RESULTS: The Bayesian network model based on the EN-ESL-GAalgorithm can effectively excavate the complex network relationships and interactive associations between heart disease and its risk factors in middle-aged and elderly people in China. CONCLUSIONS: The Bayesian network model based on the EN-ESL-GA algorithm has good applicability and application prospect in the prediction of diseases prevalence risk. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop and validate a machine learning)based model to predict the development of impaired fasting glucose (IFG) in middle-aged and older elderly people over a 5-year period using data from a cohort study. Methods: This study was a retrospective cohort study. The study population was 1855 participants who underwent consecutive physical examinations at the First Affiliated Hospital of Soochow University between 2018 and 2022.The dataset included medical history, physical examination, and biochemical index test results. The cohort was randomly divided into a training dataset and a validation dataset in a ratio of 8:2. The machine learning algorithms used in this study include Extreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), Naive Bayes, Decision Trees (DT), and traditional Logistic Regression (LR). Feature selection, parameter optimization, and model construction were performed in the training set, while the validation set was used to evaluate the predictive performance of the models. The performance of these models is evaluated by an area under the receiver operating characteristic (ROC) curves (AUC), calibration curves and decision curve analysis (DCA). To interpret the best-performing model, the Shapley Additive exPlanation (SHAP) Plots was used in this study. Results: The training/validation dataset consists of 1,855 individuals from the First Affiliated Hospital of Soochow University, yielded significant variables following selection by the Boruta algorithm and logistic multivariate regression analysis. These significant variables included systolic blood pressure (SBP), fatty liver, waist circumference (WC) and serum creatinine (Scr). The XGBoost model outperformed the other models, demonstrating an AUC of 0.7391 in the validation set. Conclusions: The XGBoost model was composed of SBP, fatty liver, WC and Scr may assist doctors with the early identification of IFG in middle-aged and elderly people. [ABSTRACT FROM AUTHOR]

Objective To explore the differences in the status of co-morbid combinations and health-related quality of life between urban and rural middle-aged and elderly people, and to provide a reference for improving the health of middle-aged and elderly people with co-morbid combinations of chronic diseases. Methods A total of 6 481 middle-aged and elderly people aged ≥50 years with at least two chronic diseases in China Healthy Aging and Reproductive Lifestyle Survey (CHARLS) 2020 were selected. The basic characteristics of urban and rural chronic disease co-morbid middle-aged and elderly people were described, the health-related quality of life was evaluated using the health utility value of EQ-5D-3L, and the combination of urban and rural chronic disease co-morbid combinations was analyzed using the association network diagram and Apriori association rule. Results The health utility value of the elderly in urban chronic disease co-morbidities was 0.8532±0.2400, which was higher than that of the elderly in rural chronic disease co-morbidities (0.8409±0.1952). The top five urban strong link chronic disease co-morbidity combination weights were: hypertension+dyslipidemia; hypertension+heart disease; hypertension+arthritis; gastric disease+arthritis; dyslipidemia+heart disease. In rural areas, there were: gastric disease+arthritis; hypertension+arthritis; hypertension+dyslipidemia; and hypertension+gastric disease. Chronic disease co-morbidities in rural middle-aged and elderly people produced 105 association rules and 86 association rules in urban. Among the top 10 association rules in terms of strength of association rules, there were 9 association rules for hypertension and 1 association rule for chronic lung disease in the rural posterior, while there were 6 association rules for hypertension, 3 association rules for dyslipidemia and 1 association rule for chronic lung disease in the urban posterior. Conclusion Health related quality of life of elderly people with chronic disease co-morbidities was higher in urban than in rural areas, with emphasis on pain management and depression and anxiety management in elderly people with chronic disease co-morbidities. There are differences in the combination of chronic disease co-morbidities in urban and rural areas, and the binary, ternary, and quaternary co-morbidity associations between common chronic disease illnesses are high, and hypertension and other chronic diseases and co-morbidities are the highest, and attention should be paid to preventive treatment of hypertension. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVD) is a major threat to public health, while cardiorespiratory fitness (CRF) is a key predictor of chronic disease. Given this, the purpose of this study was to investigate the relationship between estimated CRF (eCRF) and CVD in middle-aged and elderly Chinese people. The China Health and Retirement Longitudinal Study (CHARLS) with 4761 individuals were included in analysis. Participants were divided into three groups according to eCRF quantile in sex subgroups. Cox proportional hazards regression models were used to explore the correlation of eCRF with CVD (stroke or cardiac events). In total, 4761 participants were included in this cohort study (2500 [52.51%] women). During a 7-year follow-up from 2011 to 2018, 796 CVDs (268 Strokes and 588 cardiac events) were recorded. In multivariable-adjusted analyses, for per 1 SD increase of eCRF, the age-adjusted risk of CVD was reduced by about 18% (HR = 0.82; 95% CI, 0.72–0.93) in men, and was reduced by about 29% (HR = 0.71; 95% CI, 0.62–0.81) in women. Similar associations were also found between eCRF and stroke and cardiac events. Both subgroup and interaction analyses showed that the interaction of age had a statistically significant effect on CVD risk. ECRF was inversely associated with CVD risk (stroke or cardiac events) in both men and women. Remarkable sex and age differences exist in the effectiveness of increasing eCRF to reduce the risk of CVD. As a potential, efficient and cost-effective risk prediction tool, eCRF deserves further attention and wide application. • Higher eCRF was closely related to lower risk of adverse cardiovascular outcomes. • eCRF should be an effective target to estimate CVD risk in general population. • Sex differences need to be taken into account in actual use of CRF. [ABSTRACT FROM AUTHOR]

As the population ages, the increase in the number of middle-aged and older adults with diabetes poses new challenges to the allocation of resources in the healthcare system. Developing accurate diabetes prediction models is a critical public health strategy to improve the efficient use of healthcare resources and ensure timely and effective treatment. In order to improve the identification of diabetes in middle-aged and older patients, a Bagging-RF model is proposed. In the study, two diabetes datasets on Kaggle were first preprocessed, including unique heat coding, outlier removal, and age screening, after which the data were categorized into three age groups, 50–60, 60–70, and 70–80, and balanced using the SMOTE technique. Then, the machine learning classifiers were trained using the Bagging-RF integrated model with eight other machine learning classifiers. Finally, the model's performance was evaluated by accuracy, F1 score, and other metrics. The results showed that the Bagging-RF model outperformed the other eight machine learning classifiers, exhibiting 97.35%, 95.55%, 95.14% accuracy and 97.35%, 97.35%, 95.14% F1 Score at the Diabetes Prediction Dataset for diabetes prediction for the three age groups of 50–60, 60–70, and 70–80; and 97.03%, 94.90%, 93.70% accuracy and 97.03%, 94.90%, 93.70% F1 Score at the Diabetes Prediction Dataset. 95.55%, 95.13% F1 Score; and 97.03%, 94.90%, 93.70% accuracy; and 97.03%, 94.89%, 93.70% F1 Score at Diabetes Prediction Dataset. In addition, while other integrated learning models, such as ET, RF, Adaboost, and XGB, fail to outperform Bagging-RF, they also show excellent performance. [ABSTRACT FROM AUTHOR]

Objective To investigate the status of e-Health literacy among middle-aged and elderly people in rural areas, and to analyze its influencing factors, so as to provide a theoretical basis for improving the e-Health literacy among middle-aged and elderly people. Methods From July to August 2022, a questionnaire survey was conducted on 355 middle-aged and elderly people in rural areas of Suizhou City, Hubei Province, using a general information questionnaire and an e-Health literacy scale. Results The total e-Health literacy score of middle-aged and elderly people was (25. 94±6. 01). The results of multiple linear regression analysis showed that trust in online health information (β=0. 294), whether to actively obtain health information through the Internet (β=0. 186), gender (β=-0. 140), education level (β=0. 135), marital status (β=0. 114) were the main factors influencing e-Health literacy among rural middle-aged and older adults. Conclusion The e-Health literacy level of middle-aged and elderly people in rural areas of Suizhou City, Hubei Province was low. Under the situation of rapid development of ageing and health information technology, basic health services need to pay more attention to the e-Health literacy of rural middle-aged and elderly people and to seek a health service model for rural middle-aged and elderly people that is compatible with the development of the digital age. (目的 了解农村地区中老年人电子健康素养现状, 分析其影响因素, 为提高农村地区中老年人电子健康素养提供依据。方法 2022年7月—8月, 采用一般资料问卷、电子健康素养量表对湖北省随州市355名农村中老年人进行问卷调查。结果 湖北省随州市农村地区中老年人电子健康素养总分为(25. 94±6. 01)分。多重线性回归分析结果显示: 对网络健康信息的信任程度(β=0. 294)、是否主动通过网络获取健康信息(β=0. 186)、性别(β=-0. 140)、文化程度(β=0. 135)、婚姻状况(β=0. 114)是影响农村中老年人电子健康素养的主要因素。结论 湖北省随州市农村地区中老年人电子健康素养水平较低, 在人口老龄化与健康信息化快速发展的形势下, 基层卫生服务机构应重视农村中老年人电子健康素养, 积极寻求与数字时代发展相适应的农村中老年人健康服务模式。)

The primary objective of this study is to explore the mediating role of depression in the relationship between social participation and life satisfaction among middle-aged and elderly individuals, as well as the moderating role of relative income. To this end, we used the China Health and Retirement Longitudinal Study (CHARLS) for regression analysis to investigate whether social participation affects life satisfaction. The CHARLS data cover 150 county-level units, 450 village-level units, and 17,000 people in about 10,000 households. The "Life_satis = α + β*Soc_parti + γ*X + ε" model was used to evaluate the effect of social participation on life satisfaction. The BK method was used to test whether depression mediates between social participation and life satisfaction.Nowell et al.'s (2016) three-step test was used to determine whether relative income moderates the influence path. Our results show that social participation significantly promotes life satisfaction, but the impact of social participation on rural residents was stronger than on urban residents. Depression mediated the positive impact of social participation on the life satisfaction of middle-aged and elderly people. Relative income negatively moderated the positive impact of social participation on depression. Relative income negatively moderated the positive impact of depression on residents' life satisfaction. We suggest that promoting social participation, managing and alleviating symptoms of depression, and increasing levels of relative income are key factors in positive aging. [ABSTRACT FROM AUTHOR]

Objective To understand the current status of cardiovascular disease knowledge acquisition behavior among middle-aged and elderly people in Guangdong Province, providing valuable reference for the effective dissemination of cardiovascular disease knowledge. Methods From September to October 2023, a survey on cardiovascular dis- ease knowledge acquisition behavior was conducted among middle-aged and elderly people in Guangdong Province using a combination of offline and online methods. Results A total of 500 valid questionnaires were collected, with a male lo female ratio of approximately 2:3. The analysis of cognitive status revealed that the average total score of cardiovascular disease knowledge among middle-aged and elderly people in Guangdong Province was 12. 8 out of 20, indicating a moderate level. Significant differences in knowledge scores were found based on gender (Z=4.504, P<0.01) and place of residence (Z=2.602, P<0.01). The analysis of acquisition behavior showed that the primary motivation for middle aged and elderly people to acquire cardiovascular disease knowledge was to meet their own disease prevention and treatment needs, with 121 respondents (nearly 1/4) stating that they learned this information incidentally. Doctors were the most trusted and common source of cardiovascular disease knowledge, followed by family and friends, traditional media, and printed materials. The trust in new media was lower than that in traditional media, but WeChat and Baidu, as the most utilized new media platforms, were very close to traditional media in terms of usage. The main issue hindering the use of new media for acquiring cardiovascular disease knowledge was the overwhelming and inconsistent quality of health information. A total of 86.2% of middle aged and elderly people believed that the cardiovascular disease knowledge they ac- quired had significant utility, mainly applying it to health oriented changes in lifestyle, such as diet, sleep, and exercise. The analysis of acquisition preferences found that the most sought after types of cardiovascular disease knowledge were medical information and health preservation information, accounting for 71.4% and 71.2%, respectively. In terms of presentation formats, videos were the most favored, followed by lectures and pamphlets. Conclusion To enhance health education, doctors should be the main force in health science communication, addressing the real needs and com- prehension levels of middle aged and elderly people, leveraging close personal networks, and implementing a well planned, comprehensive approach to health education. The content should systematically cover the entire process of health management, from prevention to treatment and rehabilitation, and extend from clinical care to everyday lifestyle considerations, incorporating multidisciplinary perspectives. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of family doctor contracting on the utilization of basic public health services by middle-aged and elderly people in Ningxia. Methods Based on the program from the Natural Science Foundation of Ningxia, a multi-stage stratified random sampling method was used to select health-related data from 1 997 middle-aged and elderly individuals. The Logit model and propensity score matching method were employed to explore the impact of family doctor contracting on the utilization of basic public health services in Ningxia. The individuals who sign a contract with a family doctor were grouped into the treatment group, and individuals with similar characteristics who did not sign a contract were selected as the control group. Results The results from the Logit model and propensity score matching showed that the coefficients between family doctor contracting and the establishment of health records and utilization of health education were both significantly positive (P<0.01). The corresponding marginal effects were 0.437 and 0.358, indicating that compared to middle-aged and elderly individuals without a family doctor contract, those with a contract had a significantly higher probability of 43.7% and 35.8% for the establishment of health records and utilization of health education, respectively. After controlling for factors such as age, marital status, education level, financial support from children, and the presence of chronic diseases, the average effect of family doctor contracting on the establishment of health records ranged from 0.877 to 0.878, and the average effect on the utilization of health education ranged from 0.655 to 0.656. These results indicated that family doctor contracting had a positive promoting effect on the utilization of basic public health services by middle-aged and elderly people in Ningxia. Conclusion Signing with a family doctor is beneficial for increasing the utilization of basic public health services by middle-aged and elderly people in Ningxia. Efforts should be made to enhance publicity and improve the dissemination of information to increase awareness among middle-aged and elderly individuals. Additionally, providing a variety of personalized and precise family doctor services and strengthening policy support for family doctors to provide more service resources are recommended. [ABSTRACT FROM AUTHOR]

Objective To conduct a comparative analysis of key urinalysis indicators across different gender and age groups among middle-aged and elderly individuals in Guangdong, based on routine health checkup data from the Guangzhou Daan Clinical Testing Center. The study aims to explore the characteristics of indicator changes and understand their impact on the health of this demographic. Methods Data from urinalysis of 12,450 middle aged and elderly individuals from Guangdong, collected between May 2017 and April 2022, were randomly selected. Five key indicators-pH, nitrite, leukocytes, occult blood, and glucose were analyzed to compare distribution differences across different age groups and genders. Results Gender differences significantly influenced the positive rates of nitrite, leukocytes, and occult blood indicators (P<0.01), with females showing higher rates than males in the same age group. Age differences significantly impacted the overall pH values (P<0.01) and nitrite positive rates (P<0.05), with middle - aged individuals of the same gender having higher pH values and lower nitrite positive rates compared to elderly individuals. Middle - aged males exhibited significantly higher positive rates of occult blood and glucose compared to elderly males (P<0.05). Conclusion In middle-aged and elderly populations in Guangdong, the abnormal rates of nitrite, leukocytes, and occult blood in urinalysis in females are higher than those in males. The abnormal rates of occult blood and glucose in urinalysis in middle-aged males are higher than those in elderly males. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of smartphone usage on the quality of life among middle-aged and older adults aged 45 and above, with a focus on the moderating effect of living arrangements. Methods Middle-aged and elderly individuals aged over 45 in Shandong Province were selected using a stratified random sampling method for a questionnaire survey. The European Five Dimensional Health Scale (EQ-5D) Chinese Utility Value Score System was employed to assess health utility values. A Tobit model was utilized to analyze the relationship between smartphone use and quality of life in this demographic, considering the moderating effect of living arrangements. Results Compared to middle-aged and older adults who did not use smartphones, those who used smartphones reported lower quality of life (β=-0.030, P<0.05). Additionally, among smartphone users in this age group, living arrangements (non-living alone) exacerbated the negative impact on quality of life (β=-0.060, P<0.05). Conclusion Smartphone ownership negatively predicted the quality of life in middle-aged and older adults aged over 45, with living arrangements moderating this relationship. This study underscores the need to address the potential negative effects of excessive smartphone use on the health of middle-aged and older adults, promote quality family interactions, and advocate for balanced smartphone usage among this population. [ABSTRACT FROM AUTHOR]

With increasing age, dyslipidemia becomes a common health problem in the middle-aged and elderly population, posing a significant risk of cardiovascular disease. Aerobic exercise, as a non-pharmacological intervention, is considered to be effective in improving blood lipid levels, but the extent to which different types of aerobic exercise affect blood lipids is not clear. This study aims to investigate the effects of 12 different aerobic exercises on total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol in middle-aged and elderly people aged 45 years and over through systematic review and Bayesian network Meta-analysis of randomized controlled trials. We systematically searched relevant databases and included eligible randomized controlled trials. Bayesian network meta-analysis was used to compare the effects of 12 types of aerobic exercise on lipid levels. A total of 487 randomized controlled trials involving middle-aged and elderly people over 45 years old were included. The results of the network meta-analysis showed that all types of aerobic exercise could reduce blood lipid levels compared with no intervention in middle-aged and elderly people. In terms of total cholesterol, triglyceride, and low-density lipoprotein cholesterol, swimming had the most significant effect. For HDL cholesterol, dance showed a better effect. Studies have shown that swimming and dancing have a positive effect on improving blood lipid levels in middle-aged and elderly people. It is recommended to choose the appropriate type of exercise according to personal preference and physical condition. [ABSTRACT FROM AUTHOR]

BackgroundCurrently, nothing is known about the connection between muscle mass and thyroid hormone levels in middle-aged and elderly Chinese with normal thyroid function. The purpose of this study was to determine the potential association between muscle mass and thyroid function status in middle-aged and elderly Chinese subjects with normal thyroid function.MethodsA cohort of 1868 participants in China were included in this retrospective study; their mean age was 53.97 years, and their skeletal muscle mass index was 7.44 kg/m2. Of them, 60.97% were men. Thyroid hormone concentrations, standard biochemical indices, and the frequency of chronic illnesses were among the many factors that were evaluated. Bioelectrical impedance analysis (BIA) was used to assess the patients’ body composition. The skeletal muscle index (SMI) was calculated using the following formula: SMI = ASM (kg)/height 2 (m2), where ASM stands for appendicular skeletal muscle mass. To identify the correlations between the variables, the Spearman correlation coefficient was used. Binary logistic regression analysis was conducted to investigate the potential linkages between thyroid hormone levels and diminished muscle mass.ResultsIn this investigation, a significant correlation was observed between low muscle mass and FT3/FT4 (OR=0.044, 95% CI: 0.004–0.440, P=0.008), as well as FT3 (OR=0.697, 95% CI: 0.508–0.957, P=0.025). Conversely, no discernible correlation trend was detected with TSH (OR=0.972, 95% CI: 0.814–1.160, P=0.753) and FT4 (OR=1.97, 95% CI=0.983–1.224, P=0.1). Following adjustment for various confounding factors, including age, vitamin D levels, triglycerides, HDL-C, LDL-C, total protein, hypertension, diabetes, hyperuricemia, and overweight/obesity, across the entire study population, a positive correlation between SMI and FT3/FT4 was identified. Subsequent gender, age, and weight-stratified analyses revealed consistent correlation trends between SMI and FT3/FT4, with all interactions yielding P-values > 0.05.ConclusionOur study has revealed that among middle-aged and elderly Chinese individuals exhibiting normal thyroid function, a reduction in the free T3 to free T4 ratio is associated with a decline in muscle mass.

ObjectiveObesity has emerged as a worldwide problem. In recent years, it has been verified that there is an association between sleep duration and obesity indicators. This provides a new approach to control obesity. In this study, the relationship between duration of sleep and body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) among Americans ≥45 years old was investigated.MethodsData was collected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2014. The link between sleep duration and obesity indicators was analysed using multiple regression models and weighted smoothed curve fitting. Subgroup analysis was conducted to assess the consistency of the connection between sleep duration and obesity indicators across various groups.ResultsThis study involved 7,118 males and 7,265 females, with an average age of 62.09. After total adjustment, sleep duration was negatively correlated with BMI (β = −0.19, 95%CI: −0.26, −0.12), WC (β = −0.36, 95%CI: −0.53, −0.19) and WHtR (β = −0.27, 95%CI: −0.38, −0.17). Subgroup analyses revealed more significant negative associations between sleep duration and BMI, WC, and WHtR among non-Hispanic White participants, and those without diabetes and hypertension.ConclusionSleep duration was significantly negatively associated with BMI, WC, and WHtR, suggesting that longer sleep duration may contribute to lower obesity indicators in middle-aged and elderly Americans. Subgroup analysis showed that their negative correlation differed between races, diabetes, or hypertension status. However, additional prospective studies are required to validate these findings and investigate potential causal relationships.

As the population ages, the increase in the number of middle-aged and older adults with diabetes poses new challenges to the allocation of resources in the healthcare system. Developing accurate diabetes prediction models is a critical public health strategy to improve the efficient use of healthcare resources and ensure timely and effective treatment. In order to improve the identification of diabetes in middle-aged and older patients, a Bagging-RF model is proposed. In the study, two diabetes datasets on Kaggle were first preprocessed, including unique heat coding, outlier removal, and age screening, after which the data were categorized into three age groups, 50–60, 60–70, and 70–80, and balanced using the SMOTE technique. Then, the machine learning classifiers were trained using the Bagging-RF integrated model with eight other machine learning classifiers. Finally, the model’s performance was evaluated by accuracy, F1 score, and other metrics. The results showed that the Bagging-RF model outperformed the other eight machine learning classifiers, exhibiting 97.35%, 95.55%, 95.14% accuracy and 97.35%, 97.35%, 95.14% F1 Score at the Diabetes Prediction Dataset for diabetes prediction for the three age groups of 50–60, 60–70, and 70–80; and 97.03%, 94.90%, 93.70% accuracy and 97.03%, 94.90%, 93.70% F1 Score at the Diabetes Prediction Dataset. 95.55%, 95.13% F1 Score; and 97.03%, 94.90%, 93.70% accuracy; and 97.03%, 94.89%, 93.70% F1 Score at Diabetes Prediction Dataset. In addition, while other integrated learning models, such as ET, RF, Adaboost, and XGB, fail to outperform Bagging-RF, they also show excellent performance.

ObjectiveTo examine the association between physical activity and risk of all-cause mortality and related mediators in middle-aged and elderly people in China to provide evidence for reducing mortality in the population. MethodsData were collected from 5 727 individuals aged ≥ 45 years who completed baseline and 3 follow-up surveys in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. We used multivariable Cox proportional hazards regression models and restricted cubic spline models to examine the association between physical activity levels and risk of all-cause mortality. In addition, we conducted a mediation analysis based on body mass index (BMI), blood pressure, and blood biochemical indicators collected during follow-up. ResultsOf all the individuals analyzed, 1 813 (31.66%) were classified as having physical activity (measured in metabolic equivalents [METs]-min/week) in the lowest quartile (

The short-term associations of ambient temperature exposure with lung function in middle-aged and elderly Chinese remain obscure. The study included 19,128 participants from the Dongfeng-Tongji cohort's first (2013) and second (2018) follow-ups. The lung function for each subject was determined between April and December 2013 and re-assessed in 2018, with three parameters (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], and peak expiratory flow [PEF]) selected. The China Meteorological Data Sharing Service Center provided temperature data during the study period. In the two follow-ups, a total of 25,511 records (average age: first, 64.57; second, 65.80) were evaluated, including 10,604 males (41.57%). The inversely J-shaped associations between moving average temperatures (lag01–lag07) and FVC, FEV1, and PEF were observed, and the optimum temperatures at lag04 were 16.5 °C, 18.7 °C, and 16.2 °C, respectively. At lag04, every 1 °C increase in temperature was associated with 14.07 mL, 9.78 mL, and 62.72 mL/s increase in FVC, FEV1, and PEF in the low-temperature zone (

Abstract The rapid development of digital technology has radically changed people’s lives. Simultaneously, as the population is rapidly aging, academic research is focusing on the use of Internet technology to improve middle-aged and older people’s health, particularly owing to the popularity of mobile networks, which has further increased the population’s accessibility to the Internet. However, related studies have not yet reached a consensus. Herein, empirical analysis of the influence of mobile Internet use on the subjective health and chronic disease status of individuals in their Middle Ages and above was conducted utilizing ordered logit, propensity score matching (PSM), and ordered probit models with data from the 2020 China Health and Retirement Longitudinal Study. The study aimed to provide a theoretical basis and reference for exploring technological advances to empower the development of a healthy Chinese population and to advance the process of healthy aging. The health of middle-aged and older adults mobile Internet users was greatly improved, according to our findings. Further, the use of mobile Internet by these persons resulted in improvements to both their self-assessed health and the state of their chronic diseases. As per the findings of the heterogeneity analysis, the impact of mobile Internet use was shown to be more pronounced on the well-being of middle-aged persons aged 45–60 years compared to those aged ≥ 60 years. Further, the endogeneity test revealed that the PSM model could better eliminate bias in sample selection. The results suggest that the estimates are more robust after eliminating endogeneity, and that failure to disentangle sample selectivity bias would overestimate not only the facilitating effect of mobile Internet use on the self-assessed health impacts of middle-aged and older adults, but also the ameliorating effect of mobile Internet use on the chronic diseases of middle-aged and older adults. The results of the mechanistic analysis suggest that social engagement is an important mediating mechanism between mobile Internet use and the health of middle-aged and older adults. This implies that mobile Internet use increases opportunities for social participation among middle-aged and older adults, thereby improving their health.

The rapid development of digital technology has radically changed people's lives. Simultaneously, as the population is rapidly aging, academic research is focusing on the use of Internet technology to improve middle-aged and older people's health, particularly owing to the popularity of mobile networks, which has further increased the population's accessibility to the Internet. However, related studies have not yet reached a consensus. Herein, empirical analysis of the influence of mobile Internet use on the subjective health and chronic disease status of individuals in their Middle Ages and above was conducted utilizing ordered logit, propensity score matching (PSM), and ordered probit models with data from the 2020 China Health and Retirement Longitudinal Study. The study aimed to provide a theoretical basis and reference for exploring technological advances to empower the development of a healthy Chinese population and to advance the process of healthy aging. The health of middle-aged and older adults mobile Internet users was greatly improved, according to our findings. Further, the use of mobile Internet by these persons resulted in improvements to both their self-assessed health and the state of their chronic diseases. As per the findings of the heterogeneity analysis, the impact of mobile Internet use was shown to be more pronounced on the well-being of middle-aged persons aged 45–60 years compared to those aged ≥ 60 years. Further, the endogeneity test revealed that the PSM model could better eliminate bias in sample selection. The results suggest that the estimates are more robust after eliminating endogeneity, and that failure to disentangle sample selectivity bias would overestimate not only the facilitating effect of mobile Internet use on the self-assessed health impacts of middle-aged and older adults, but also the ameliorating effect of mobile Internet use on the chronic diseases of middle-aged and older adults. The results of the mechanistic analysis suggest that social engagement is an important mediating mechanism between mobile Internet use and the health of middle-aged and older adults. This implies that mobile Internet use increases opportunities for social participation among middle-aged and older adults, thereby improving their health. [ABSTRACT FROM AUTHOR]

Cognitive frailty (CF) is an important geriatric syndrome and is reversible. It is crucial to develop preventive interventions for CF. We aimed to explore the associations between CF and its associated factors in Chinese aged 45 years and above. Based on the available data of 3 waves in China Health and Retirement Longitudinal Study from 2011 to 2015, 16,071 individuals aged 45 years and above from 3 waves were included. Based on the health ecology model, the associated factors were classified as downstream, midstream and upstream factors. Generalized hierarchical linear model including time level, individual level, and province level was applied to analyze the associations between factors and CF. Multilevel factors have different effects on physical and cognitive function. In the downstream, old age, female, underweight, chronic diseases, and depression were risk factors of reversible CF and potentially reversible CF, and overweight was their protective factor. In the midstream, short or long night sleep duration was their risk factor, and > 30 and ≤ 60 min afternoon naps, alcohol drinking, and participation in social activities were their protective factors. In the upstream, living in rural areas was their risk factor, and high educational level, household consumption and GDP per capita were their protective factors. Physical function and cognitive function are affected differently by multiple factors. The occurrence and development of physical frailty and cognitive impairment may have some common mechanisms. CF can be influenced by multilevel factors, and multilevel and comprehensive management of CF should be achieved. Cognitive frailty was correlated with multilevel factors, including downstream, midstream, and upstream factors. It is crucial to focus on individual interventions such as physiological factors, psychological factors and health behaviors, especially the elderly, women and those with depression. Socioeconomic status was associated with the lower prevalence of cognitive frailty. • Physical function and cognitive function were affected differently by multiple factors. • Cognitive frailty was associated with multilevel factors, including downstream, midstream, and upstream factors. • It is crucial to focus on individual interventions such as physiological, psychological, and health behavior factors. • Socioeconomic status was associated with the lower risk of cognitive frailty. [ABSTRACT FROM AUTHOR]

As the resident space for activities of middle-aged and elderly people, community carries the needs of residents such as daily activities and public communication, and the diversity of activity participation has a positive impact on the health level of middleaged and elderly people. From the perspective of multi-dimensional participation forms, based on community survey data in Taiyuan City, a structural equation model was constructed to comprehensively analyze the participation pathways and systems of middle-aged and elderly people, understand their differences and correlations, and analyze their potential relationships and influencing mechanisms on life satisfaction. The results show that place attachment can positively regulate the life satisfaction of middle-aged and elderly people, directly and indirectly produce a total effect value of 0. 595, and place identity can improve the vitality of community participation. The total effect size of offline community participation on life satisfaction was 0. 132, and the total effect size of online participation was 0. 059. Offline community participation could affect online participation, the relationship between them is mutually reinforcing. Demographic variables can also affect the life satisfaction of middle-aged and elderly people to a certain extent, and the degree of influence from the largest to the smallest is education level, living style, work type, age, gender. According to the results of the study, the optimization strategy of the middle-aged and elderly community participation promotion is proposed, which can provide reference for the stimulation and enhancement of the vitality of urban community participation. [ABSTRACT FROM AUTHOR]

Background With the change of lifestyle, atherosclerotic cardiovascular disease (ASCVD) is showing a younger trend as an important component of ASCVD. Snoring as a common health problem related to sleep breathing, which is a characteristic indicator of obstructive sleep apnea-hypopnea syndrome (OSAHS) . However, there are few studies on the correlation between snoring and ASCVD, and it is still necessary to identify this factor to provide scientific basis for early intervention. Objective To investigate the correlation between snoring frequency and 10-year risk of ASCVD in middle-aged and elderly population. Methods From 2018 to 2021, a multi-stage stratified cluster sampling method was adopted to investigate the permanent residents aged 35-75 in Jing'an District. General information of the subjects was collected through questionnaire survey, and laboratory tests were used to collect total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) . Snoring frequency: snoring 1-2 times per week was considered as mild snoring, snoring 3-4 times per week was considered as moderate snoring, and snoring 5-7 times per week was considered as severe snoring; the 10-year risk of ASCVD 0.05) . Further analysis of the relationship between snoring and ASCVD risk factors showed that severe snoring was a risk factor for hypertriglyceridemia, hypercholesterolemia, hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia, and moderate snoring was a risk factor for hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia compared with no snoring (P

Mao-Min Jiang,1,&ast; Ye-Wei Xiao,2,&ast; Zhi-Liu Liao3– 5 1School of Public Affairs, Xiamen University, Xiamen, 361005, People’s Republic of China; 2School of Basic Medical Science, Southwest Medical University, Luzhou, 646000, People’s Republic of China; 3School of Public Health, Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 4Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 5Research Center for Public Health Security, Chongqing Medical University, Chongqing, 400016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhi-Liu Liao, Email liaozhiliu@cqmu.edu.cnObjective: To understand the status of media exposure, social support, self-efficacy, and health literacy among middle-aged and older adults in China, and explore the impact path of media exposure on the health literacy of this population, providing a reference for promoting their physical and mental health.Methods: From July to November 2022, a multi-stage random sampling method was employed to survey 16,938 Chinese middle-aged and older adults aged 46 and above. Structural equation modeling and statistical analysis were conducted using LISREL 8.8 and Mplus 8.3 software.Results: The average score for media exposure among Chinese middle-aged and older adults was (18.55± 5.36), perceived social support was (60.68± 12.51), self-efficacy was (28.76± 5.40), and health literacy was (35.49± 6.05). Statistical results revealed that media exposure has a positive impact on the health literacy of middle-aged and older adults, with a direct effect of 0.091 (p < 0.001). Mediation analysis showed that media exposure can affect the health literacy of this population through the independent mediating effects of perceived social support (β = 0.013, p < 0.001) and self-efficacy (β = 0.029, p < 0.001), as well as through a chain mediation effect involving perceived social support and self-efficacy (β = 0.015, p < 0.001).Conclusion: As a pathway for health information dissemination, media exposure plays a crucial role in the intervention of health literacy among middle-aged and older adults. Perceived social support and self-efficacy not only have independent mediating effects but also significant chain mediating effects in the relationship between media exposure and health literacy among this population. Therefore, improving the health literacy of middle-aged and older people can be popularized through media and improved in a multi-path, all-round, and precise way with the help of related technologies and social forces from which media literacy can be improved.Keywords: middle-aged and elderly people, media contact, social support, self-efficacy, health literacy

Abstract Background With the continuing impact of the aging population, medical-elderly care integrated institutions, as a way to bear the pressure of medical and elderly care, effectively ensure the quality of life of the elderly in their later years. Objectives To explore the preferences of medical-elderly care integrated institutions among Chinese middle-aged and older people and to provide a reference for establishing elderly-oriented development of medical-elderly care integrated institutions. Methods In this study, a discrete choice experiment (DCE) was used to investigate the preferences of people aged 45 years and older in medical-elderly care integrated institutions in China from October 20, 2022, to November 10, 2022. A mixed logit regression model was used to analyze the DCE data. Participants’ willingness to pay for each attribute was also calculated. Results Data from 420 participants who provided valid responses were included in the analysis. In terms of the choice preference, moderate service quality (vs. poor service quality: β = 1.707, p

OBJECTIVE: This work aimed to construct and validate a model for predicting distant metastasis (DM) in thyroid carcinoma (TC) patients aged≥50. PATIENTS AND METHODS: The research data were collected from the Surveillance, Epidemiology, and End Results (SEER) program databases via SEER*Stat software (https://seer. cancer.gov/). Logistics regression was used to screen the independent risk factors for TC patients. The nomogram was constructed and validated based on the logistics regression results for predicting DM occurrence in TC patients. Moreover, the characteristic curves (ROC) were used to assess the predictive performance. The decision analysis curve (DCA) and the calibration curve were used to test this nomogram's accuracy and discrimination. Additionally, we analyzed survival and risk scores in TC patients with metastasis using the Kaplan- Meier (KM) method. RESULTS: A total of 11,166 TC patients were divided into a training set and a validation set. The results showed that topography (T), lymph node metastasis (N), and (grade) G were crucial risk factors for predicting DM. ROC analysis showed that the model had a good discriminative ability both in the training and validation set. The DCA curve showed greater net benefits across a range of DM risks for the nomogram in the training and validation set. Survival analyses showed that the metastasis cases with low-risk scores have shown a poorer prognosis in this study, both in the training and validation set. CONCLUSIONS: The nomogram model had excellent predictive performance and net benefit for predicting DM of TC patients aged ≥50. The model can help doctors develop treatment plans for their patients. [ABSTRACT FROM AUTHOR]

Based on the data of 2018 China Health and Retirement Longitudinal Study (CHARLS), the study used linear regression model, stepwise regression and product of coefficients approach to analyze the influence of volunteer activity participation on life satisfaction and the mediating role of depression. Moreover, the age⁃group differences in the mechanism were further explored. The findings revealed that volunteer activity participation was both directly and indirectly associated with life satisfaction among middle - aged and elderly people (β =0.041, P<0.05). Depression was found to mediate the relationship of volunteer participation to life satisfaction, and the mediating effect accounted for 22.75%. Furthermore, the influence coefficient and mechanism of volunteer activity participation on different age groups were obviously different. The results had important values for preventing and intervening depression, improving the mental health and life satisfaction among middle-aged and elderly people, and promoting active aging. [ABSTRACT FROM AUTHOR]

Background and Objectives: The older members of a population might experience unmet medical needs, despite desiring medical care due to activity limitations driven by their perception of aging. This study conducted a cross-sectional analysis of the association between perceived activity restriction (PAR) due to people's own perception of aging and unmet medical needs (UMN) in late middle-aged and older Koreans based on the Korean National Health and Nutrition Examination Survey (KNHANES). Materials and Methods: The 2016–2020 KNHANES was used to analyze a total of 2008 participants among groups aged 45 years or older by applying individual weights imposed from the raw data. The independent variable of PAR was assessed using self-reported questionnaires based on the global activity limitation indicator. Also, the dependent variable of UMN, referring to the state in which a patient's medical care or service was insufficient, inadequate, or lacking, was assessed using a single question. After excluding missing values, the data on 2008 individuals were analyzed using a chi-square test, weighted logistic regression, and a stratified analysis of gender, age, and the presence of chronic illnesses. Results: The group that experienced PAR had an OR 2.13 higher (odds ratio [OR]: 2.13; 95% confidence interval [CI]: 1.27–3.56) to present UMN than the group that did not experience PAR. Furthermore, the results of the stratified analysis indicated that, in the group of female participants with chronic illness and in the group of elderly people, experiencing PAR was associated with a higher experience of UMN. Conclusions: There was a close association between PAR and UMN. In particular, when PAR occurred in the group of female participants with chronic illness and in the group of elderly people, the incidence rate of UMN was also found to be high. This finding highlights the need for policies and institutional measures to reduce UMN within vulnerable groups with an increased risk of medical inaccessibility due to activity restriction. [ABSTRACT FROM AUTHOR]

BackgroundMetabolic syndrome (MetS) is a global health concern, and it is particularly harmful to middle-aged and elderly individuals. Life Element Eight (LE8), a measure to improve cardiovascular health, may offer benefits for MetS. Herein, we examined the relationship between LE8 and MetS among middle-aged and elderly individuals, and elucidated the role of biological aging and inflammation in this process.MethodsWe obtained the LE8 scores of 2,901 Americans, along with their biological aging indicators (Biological age, Phenotypic age, Serum Klotho), and computed their inflammatory indicators SII, DII. Using logistic regression model, we assessed the association among inflammatory markers, Biological aging, LE8 and MetS. Additionally, we generated restricted cubic spline (RCS) plots to display trends in significant variables in logistic regression. Using parallel mediation analysis, we evaluated the possible mediating role of various factors in the risk relationship between LE8 and MetS.ResultsOur examination revealed that higher LE8 scores were associated with a lower incidence of MetS in a fully adjusted model. The high LE8 subgroup had a 79.73% reduction in the risk of MetS compared to the low subgroup with an OR = 0.2027 (95% Cl 0.0871, 0.4714), with similar correlations between health factor scores and MetS risk. Biological aging mediated the associations between LE8, health behaviors and health factor scores and MetS risk.ConclusionA rise in the LE8 score among middle-aged and elderly individuals is a protective factor for MetS, and this association may be partially mediated by biological aging, suggesting that LE8 may reduce the risk of MetS by ameliorating aging.

ObjectiveTo provide a scientific basis for dietary guidance for older adults in China， the correlation between the total intake of fruit and vegetables and cognitive function was explored.MethodsA total of 406 people aged 55 years or older who participated in the 2015 Chinese Health and Nutrition Survey （CHNS） in Hubei Province were included in this study. Age， sex， urban or rural status， marital status， educational level， income， smoking， drinking， physical activity， red meat intake， fish intake， total energy intake， body mass index （BMI）， and hypertension were recorded. Multiple linear regression and a 95% confidence interval （95%CI） were used to evaluate the linear partial regression coefficients between fruit and vegetable intake and cognitive function.ResultsThe mean age of the subjects was 64.79±7.57 years old， the mean total fruit and vegetable intake was 330.18±165.56 g/d， and the mean cognitive score was 13.44±5.66 points. In the fully adjusted model， compared with the Q1 group， the linear partial regression coefficient and 95%CI of the Q4 group were 1.91 and 0.08-3.75. Compared with the daily intake of vegetables only， the linear partial regression coefficient and 95%CI for the daily intake of vegetables and fruits were 1.40， 0.15-2.73.ConclusionA higher fruit and vegetable intake is associated with better cognitive function in middle-aged and elderly individuals. Fruit intake should be ensured while consuming vegetables.

Background Insufficient physical activity is one of the most important public health problems in the 21st century and studies have found an association between physical activity and mortality. The effect of physical activity on mortality risk has attracted much attention in recent years, but few studies have reported the relationship between physical activity and all-cause mortality risk in different populations. Objective To explore the relationship between physical activity and all-cause mortality risk in middle-aged and older adults (45 years old and above) in China. Methods Based on the data of China Health and Retirement Tracking Survey (CHARLS) from 2011 to 2018, a total of 2 799 middle-aged and older adults from the 2011 baseline population of the CHARLS were selected as the research subjects on September 10, 2022, their baseline data such as demographic variables, lifestyle variables, and number of chronic diseases were collected, and physical activity level was evaluated based on the International Physical Activity Questionnaire (IPAQ) as low level physical activity〔600 metabolic equivalent (MET) /week) 〕, moderate level of physical activity (600-3 000 MET/week), high level of physical activity (3 000 MET/week). The follow-up period was from 2011 to 2018, and data from 2013, 2015 and 2018 were selected for follow-up, with all-cause death as the endpoint event, and the subjects were divided into the survival group (n=2 424) and all-cause death group (n=375) according to their survival status. Cox proportional hazard regression model was used to analyze the relationship between physical activity level and all-cause mortality risk in middle-aged and older adults, sensitivity analysis and stratification analysis were also performed. Results During the 7-year follow-up, 375 cases of all-cause death occurred among 2 799 middle-aged and older adults with the incidence of all-cause death of 13.40%. There were statistically significant differences in physical activity level, gender, age, marital status, education level, ADL limitation, BMI, smoking, alcohol consumption and the number of chronic diseases between the survival group and all-cause death group (P

Background The scale and follow-up time of studies related to the association between sleep duration and all-cause mortality in middle-aged and older adults vary widely, and the results of studies such as correlations and recommended sleep duration remain controversial. Objective To explore the association between sleep duration and the risk of all-cause mortality in middle-aged and older adults. Methods From January to December 2022, the longitudinal study cohort was created based on the case ID numbers of coding manual combined with baseline and follow-up data of the China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Study (CLHLS) databases from January to December in 2022, which ultimately included 43 922 respondents. Social demographics, health status and health-related behaviors, sleep duration and death related information were extracted from CHARLS and CLHLS databases, recoding and variable transformations were performed according to the measurement and evaluation criteria of relevant indicators. The Kaplan-Meier method of Log-Rank test was used to plot survival curves, and the Cox proportional hazard regression model was used to explore the relationship between sleep duration and mortality risk in the middle-aged and older adults, followed by unrestricted cubic spline to observe the effect of the continuous-type variable of sleep duration on mortality risk. Results Among 43 922 middle-aged and older adults with a median follow-up of 6 years and an average sleep duration of 7.32 h, 9 369 cases (21.33%) had sleep duration of≤5 h, 7 779 cases (17.71%) had sleep duration of >5-6 h, 295 cases (0.67%) had sleep duration of >6-7 h, 15 611 cases (35.54%) had sleep duration of >7-8 h, 2 567 cases (5.84%) had sleep duration of >8-9 h, 5 011 cases (11.41%) had sleep duration of >9-10 h and 3 290 cases had sleep duration >10 h (7.49%) . Kaplan-Meier survival analysis showed that middle-aged and older adults with moderate sleep duration (>6-7 h) had the highest probability of survival, and those with extra-long sleep duration (>10 h) had the lowest probability of survival. Cox regression model results showed that compared with middle-aged and older adults with sleep duration >10 h, middle-aged and elderly adults with sleep duration of ≤5 h〔HR (95%CI) =1.19 (1.09, 1.29) , P7-8 h〔HR (95%CI) =1.16 (1.08, 1.25) , P8-9 h〔HR (95%CI) =1.32 (1.19, 1.46) , P9-10 h〔HR (95%CI) =1.12 (1.04, 1.22) , P7.97-10.00 h with all-cause mortality risk. Conclusion Middle-aged and older adults with moderate sleep duration had the highest probability of survival, so the recommended sleep duration for middle-aged and older adults is 5-7 h.

This cross-sectional study correlated the muscle mass reduction with serum uric acid and urinary albumin in middle-aged and elderly men having type 2 diabetes. The study subjects were 288 middle-aged and elderly male patients with type 2 diabetes (T2DM) admitted to our hospital. They were divided into sarcopenia (n = 95) and non-sarcopenia (n = 193) groups based on whether diagnosed with sarcopenia or not. The relevant clinical information of patients was collected. Single factor analysis and multiple factor regression analysis were employed to explore the influencing factors of sarcopenia. A binary logistic regression analysis model was established for the sarcopenia probability in middle-aged and elderly men with T2DM. Hosmer and Lemeshow test evaluated the Goodness of fit of probability model. ROC (Receiver Operating Characteristic) curve was drawn by SPSS and the predictive value of prediction model was evaluated. The univariate analysis depicted that the patients in sarcopenia group compared to those in non-sarcopenia were older with lower BMI (Body Mass Index), lower UA (Uric Acid) and higher CRP (C-reactive Protein). The differences were statistically significant (p < 0.05). The binary logistic regression analysis exhibited that the age and UACR (Urine Albumin-to-Creatinine Ratio) were the risk factors, while BMI and UA were the protective factors for sarcopenia in middle-aged and elderly men with T2DM. For middle-aged and elderly male patients with T2DM, age and UACR were the risk factors, and BMI and UA were the protective factors for sarcopenia. The changes in above-stated indicators of patients with T2DM should be clinically monitored, and early and active intervention be given to high-risk groups for minimizing the sarcopenia occurrence.

Abstract Background This study aims to identify the current status and factors influencing self-management of knee discomfort in middle-aged and elderly people in China. Methods A stratified multistage cluster sampling method was used to select participants from communities in China from January 15 to May 31, 2020. A cross-sectional survey was conducted using the general information questionnaire and the Knee Joint Discomfort Self-management Scale. Univariate analysis and a generalized linear model were used to analyze the factors influencing self-management. Results The prevalence of knee discomfort was 77%. Moderate to severe discomfort accounted for 30.5%. The average item score of self-management in 9640 participants was 1.98 ± 0.76. The highest and lowest levels were: ‘daily life management’ and ‘information management’. Gender, ethnicity, education level, economic source, chronic disease, knee pain in the past month, and the degree of self-reported knee discomfort were significant predictors of self-management. Conclusion The self-management of knee discomfort in middle-aged and elderly people is poor, and the degree of discomfort is a significant predictor. Healthcare providers should consider socioeconomic demographic and clinical characteristics to help these individuals improve their self-management skills. Attention should also be given to improving their ability to access health information and making them aware of disease risks.

Objective To explore the current dietary patterns of different obesity metabolic phenotypes in the middle-aged and elderly population in Sichuan area. Methods From the baseline survey of the Natural Population Health Cohort Study at West China Hospital, Sichuan University from 2019-2021, 15 160 eligible middle-aged and older adults were screened out, and then based on their obesity metabolic phenotypes, they were divided into metabolic healthy non-obesity (MHNO), metabolic unhealthy non-obesity (MUNO), metabolic healthy obesity (MHO) and metabolic unhealthy obesity (MUO) groups. Dietary survey was conducted by food frequency questionnaire. The dietary pattern was extracted by principal component analysis. ANOVA was performed to compare the differences in energy and nutrients among the participants with different dietary patterns. Chi-square test was used to compare the distribution of dietary patterns among people with different obese metabolic phenotypes, and stratified analysis was performed by gender and age groups. Results Among the 15 160 middle-aged and elderly participants in Sichuan area, there were 8 340 (55.0%) in the MHNO group, 4 789 (31.6%) in the MUNO group, 763 (5.0%) in the MHO group, and 1 268 (8.4%) in the MUO group. The dietary patterns of these participants mainly consisted of following 4 types: legumes and fruits (22.5%), rice, flour and pickled products (25.5%), offal and drinks (21.1%) and egg and milk (30.9%). The dietary patterns of the different obesity metabolic phenotypes were distributed as follows: the MHNO, MUNO and MHO groups had a predominantly egg and milk diet, while the MUO group had a predominantly rice, flour and pickled products diet. There were statistical differences in the distributions of dietary patterns among different obesity metabolic phenotypes (P < 0.05): the dietary patterns of rice, flour and pickled products accounted for the following percentages among different obesity metabolic phenotypes: MUO>MUNO>MHNO; the dietary patterns of egg and milk were lower in the MUO group than in the MHNO and MUNO groups. The distribution of dietary patterns for the metabolic phenotypes of obesity was statistically different in all age groups of women(P < 0.05). For the women aged 45- < 60 years, the distribution of dietary patterns of obesity metabolic phenotypes was similar to that found in the total population. For the women aged ≥60 years, the offal and drinks dietary pattern was more common in the MUO group than the MHNO and MUNO groups. Conclusion There are differences in the distribution of dietary patterns among middle-aged and elderly people with different obesity metabolic phenotypes in Sichuan area. It is recommended that the MUO people should reduce the intake of rice, flour and pickled products and increase the intake of eggs and milk in their daily diet. In addition, for the female MUO people ≥60 years of age, the intake of offal and beverages should be reduced appropriately.

ObjectiveTo examine treatment outcome of falls injury and its influencing factors in middle-aged and elderly inpatients and to establish a nomogram prediction model of treatment efficacy for providing evidence to effective treatment of falls injury of the inpatients. MethodsThe medical records of 1 500 patients aged 45 years and above and hospitalized due to falls injury from January 2017 through January 2022 were collected from Fenyang Hospital of Shanxi province. Unconditional multivariate logistic regression model was used to analyze factors affecting treatment efficacy of falls injury of the inpatients. A nomogram model for predicting falls injury treatment efficacy was established with R4.2.0 software; the discrimination of the established model was evaluated with the area under the receiver operating characteristic curve (AUC) and the goodness of fit of the model was assessed with Hosmer-Lemeshow test and calibration curve. ResultsOf all the inpatients, 1 017 (67.8%) were cured at the discharges. The results of logistic regression analysis showed that the inpatients with following characteristics were more likely to have poor treatment outcome: with emergency admission to hospital, suffering from torso injury, with other unspecified falls injury, and being assessed as having an age-adjusted Charlson comorbidity index (aCCI) of 6 and greater; while, the inpatients with falls-induced upper or lower limb injury and having moderate or severe falls injury were more likely to have a better treatment outcome. A nomogram prediction model involving 5 variables was constructed, with an AUC of 0.732 (95% confidence interval: 0.705, 0.759) and a good goodness-of-fit (χ2 = 12.692, P = 0.123). ConclusionAdmission mode, body part of falls injury, type of falls injury, severity of falls injury, and aCCI are closely related to treatment outcome of falls injury in middle-aged and elderly inpatients. The established nomogram model covering those variables for predicting treatment outcome of falls injury could be helpful for individualized and targeted treatment of falls injury among middle-aged and elderly inpatients.

Objective To investigate the content and distribution of muscle and fat in middle-aged and elderly people in Youjiang District of Baise City, and to provide basic data for in-depth study of anthropological in Baise City. Methods A total of 781 permanent residents (living continuously for more than or equal to 5 years) were randomly selected from Youjiang District of Baizi City in Guangxi, including 333 males and 448 females. The residents who were over 40 years old were divided into age groups, and their height, waist and hip circumference and body composition were measured. The muscle and fat content of middle-aged and elderly people in different genders were investigated.SPSS20.0 statistical software was used to analyze the data. Results A total of 781 middle-aged and elderly people completed the survey. The muscle mass of men was higher than that of women [ (45.21±5.54) kg vs. (33.78±3.58) kg],and the body fat rate was lower than that of women [ (21.76±5.91) % vs. (31.51±6.58) %].The muscle mass, fat mass, and body fat rate between males and females in the same age group were compared, the differences were statistically significant (P＜0.01) .Conclusion The total muscle mass of middle-aged and elderly male and female residents in Youjiang District of Baise City decreases with age, while the body fat rate increases with age. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, there are many treatment methods for low back pain; however, most of them cannot fundamentally solve the problem. How to effectively reduce the incidence of low back pain is worth thinking about by clinical workers. OBJECTIVE: To explore the influencing factors of low back pain in middle-aged and elderly people in China, construct a nomogram prediction model for low back pain and guide exercise and rehabilitation therapy with different intensities and frequencies according to the occurrence probability of low back pain to reduce the incidence of low back pain. METHODS: The follow-up data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 were used to determine whether low back pain occurred or not. Fourteen variables, including age, sex, marriage, place of residence, exercise, education level, smoking, alcohol consumption, depressive symptoms, body mass index, sleep duration, left hand muscle strength, right hand muscle strength and waist circumference, were used as independent variables to analyze the independent influencing factors of the occurrence of low back pain in middle-aged and elderly people and construct the nomogram prediction model. The calibration curve and receiver operating characteristic curve of the model were drawn, and the C index was calculated to evaluate the discrimination and calibration degree of the prediction model. RESULTS AND CONCLUSION: (1) A total of 6 059 middle-aged and elderly patients were selected. Patients with low back pain were selected as the disease group (n=1 263), and those without low back pain were selected as the control group (n=4 796). The original data set was constructed. The original data set was divided into training set (n=4 243) and verification set (n=1 816) at a ratio of 7:3. (2) According to the results of multivariate logistics regression analysis, four variables, including education level, depressive symptoms, sleep duration and right hand muscle strength, were identified to construct the nomogram prediction model, and the area under the receiver operating characteristic curve of the model was 0.726. The calibration curve fit was good, and the calibration curve generated by bootstrops method was good for the internal verification of the model. The validation set was used for the external verification. The area under the receiver operating characteristic curve of external verification was 0.740 and the calibration graph fit was good, indicating that the model had good discrimination and calibration degree. (3) According to the factors such as education level, depressive symptoms, sleep duration, and right hand grip strength, the probability of occurrence of low back pain can be predicted by using the nomogram prediction model, and early prevention can improve the quality of life of middle-aged and elderly people. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine spatial and temporal distribution patterns of household-based multidimensional health poverty (MHP) indexes among middle-aged and elderly populations in China, and to provide evidence to precise elimination of MHP in the populations. MethodsThe data of the analysis were extracted from four rounds of China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011, 2013, 2015, and 2018 across China, which collected the information of residents aged ≥ 45 years in 37 296 households on demographics, income and consumption, family structure, economic support, health status, health service utilization and medical insurance. The MHP was assessed and deconstructed with self-established health poverty evaluation index system and multidimensional health poverty measurement index (MHPI) covering three dimensional components (health right, health capability and health risk) of MHP. The year- and region-specific distribution of MHPI were described. ResultsFor all the middle-aged and elderly residents surveyed in 2011, 2013, 2015, and 2018, the health MHPI were 0.320, 0.326, 0.349, and 0.29 and the MHP prevalence were 69.7%, 69.0%, 71.9%, and 63.0%, respectively. The mean values of index measuring the contribution of health right, health capacity and health risk to MHP were 0.143, 0.450 and 0.416 for all the residents surveyed in the four rounds of CHARLS study. The results of regional decomposition analysis on MHPI showed that following six provincial-level administrative divisions (PLADs) could be assessed as with severe prevalence of health poverty in 2011: Guizhou, Gansu, Xinjiang Uygur Autonomous Region (Xinjiang), Sichuan, Anhui, and Jilin, with the mean MHPI of 0.365, 0.364, 0.395, 0.377, 0.402, and 0.413,respectively; in 2013, the six PLADs assessed as having severe prevalence of health poverty were Yunnan, Qinghai, Inner Mongolia Autonomous Region (Inner Mongolia), Sichuan, Anhui, and Guizhou and the mean MHPI for those PLADs were 0.359, 0.361, 0.381, 0.378, 0.389, and 0.402; while in 2015 the number of PLADs with severe prevalence of health poverty increased to 16, including Yunnan (mean MHPI = 0.395), Xinjiang (0.388), Qinghai (0.448), Sichuan (0.406), Inner Mongolia (0.39), Anhui (0.388), Chongqing (0.391), Guizhou (0.373), Tianjin (0.370), Heilongjiang (0.366), Guangxi (0.362), Shandong (0.362), Jiangxi (0.359), Jilin (0.355), Fujian (0.351), and Liaoning (0.350); but in 2018, only 3 PLADs (Sichuan, Guizhou, and Yunnan, with the mean MHPI of 0.352, 0.352, and 0.351) could be assessed as with severe prevalence of health poverty. ConclusionAccording to this analysis, both mean index and prevalence of health poverty declined generally among middle-aged and elderly populations in China during 2011 – 2018; there were regional differences in health poverty prevalence and the multidimensional health poverty was more severe in southwest region.

Background: This study aims to identify the current status and factors influencing self-management of knee discomfort in middle-aged and elderly people in China. Methods: A stratified multistage cluster sampling method was used to select participants from communities in China from January 15 to May 31, 2020. A cross-sectional survey was conducted using the general information questionnaire and the Knee Joint Discomfort Self-management Scale. Univariate analysis and a generalized linear model were used to analyze the factors influencing self-management. Results: The prevalence of knee discomfort was 77%. Moderate to severe discomfort accounted for 30.5%. The average item score of self-management in 9640 participants was 1.98 ± 0.76. The highest and lowest levels were: 'daily life management' and 'information management'. Gender, ethnicity, education level, economic source, chronic disease, knee pain in the past month, and the degree of self-reported knee discomfort were significant predictors of self-management. Conclusion: The self-management of knee discomfort in middle-aged and elderly people is poor, and the degree of discomfort is a significant predictor. Healthcare providers should consider socioeconomic demographic and clinical characteristics to help these individuals improve their self-management skills. Attention should also be given to improving their ability to access health information and making them aware of disease risks. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to analyse the relationship between Tai Chi exercise habits and depression tendency and sleep quality in people practicing Tai Chi in Chengdu, China. A total of 1352 Tai Chi practitioners aged 50–79 years old were divided into six groups according to age and gender for Tai Chi exercise habits, depression tendency and sleep quality. The frequency of weekly Tai Chi practice and duration of single Tai Chi practice have a significant positive correlation with the exercise years. For female subjects who had long-term Tai Chi exercise, depression decreased with the duration and weekly frequency of a single exercise. Tai Chi exercise habits reduced sleep disturbance scores (in the male group aged 60–69 years old, exercise years, r = −0.242, p = 0.004) and sleep duration (in the male and female group aged 70–79 years old, duration of single Tai Chi practice, r = −0.334, p = 0.035; r = −0.235, p = 0.029), suggesting that long-term Tai Chi exercise may reduce the trend of poor sleep quality due to increased ageing. [ABSTRACT FROM AUTHOR]

Background: According to the World Population Outlook (2019), people over 65, usually accompanied by various chronic diseases, will make up 16% of the population in 2050. Therefore, the health problems of middle-aged and elderly people are becoming the focus of current global attention. Some scholars have found that the health of middle-aged and elderly people is related to the childhood socio-economic environment. Methods: Using the China Health and Retirement Longitudinal Study (CHARLS) data, this paper innovatively constructed four measurement dimensions of health (namely, self-rated health, physical health, emotional health, and mental health). Moreover, logistic regression was used to explore the impact of childhood socio-economic environment (such as parent's education level, work experience, etc.) on the health status of middle-aged and elderly people. Results: Compared with a poor childhood social-economic environment, a good childhood socio-economic environment is more advantageous to the self-rated health of middle-aged and elderly people, especially a childhood socio-economic environment close to the medium level; the psychological health of middle-aged and elderly people who have experienced an adverse childhood socio-economic environment was better than those who did not; the childhood socio-economic environment has no apparent impact on the cognitive situation of middle-aged and elderly people. Conclusions: Some policy implications can be drawn. For example, the government should vigorously introduce policies to help migrant workers' children receive education in cities and provide special education guarantees for migrant workers' children. Societies and families should also pay more attention to the childhood socio-economic environment. [ABSTRACT FROM AUTHOR]

There are many studies on the impact of physical activity on health but few studies on the relationship between physical activity and medical expenditure among the elderly. Based on the China Health and Retirement Longitudinal Survey (CHARLS) database and selected 4456 valid samples, this paper used a two-part model to analyze the effects of high, moderate, and low physical activity intensity on medical expenditure. It is found that the intensity of physical activity was negatively correlated with medical expenditure, and the medical expenditure of the high physical activity intensity group was significantly lower than that of the low physical activity intensity group. For example, compared to people with no physical activity, the total medical expenditure decreased by 22.4%, 40.4%, and 62.5% per week in those with low, moderate, and high physical activity intensity. Thus, the government should provide more places for the elderly to exercise, planning special exercise areas for the elderly in community playgrounds, such as a dancing square, which will also help the elderly to increase their amount of exercise per week and develop a daily exercise habit. [ABSTRACT FROM AUTHOR]

Background With the severe situation of the increasingly population aging in China, the health problems of the middle-aged and older adults can not be ignored, attracting much attention on the health equity among the rural-dewlling middle-aged and older adults. The geographic remoteness of southern mountainous area in the Ningxia Hui Autonomous Region causes the health conditions of the middle-aged and older adults more unoptimistic. However, there are relatively few studies on the health equity among the middle-aged and older adults in this area. Objective To investigate the health equity of the middle-aged and older adults in the pilot counties of medical reform in the Ningxia Hui Autonomous Region (Haiyuan County and Yanchi County) and analyze the contribution degree of various influencing factors to health inequality, so as to provide a basis for improving the health of the middle-aged and older adults and relevant health policies. Methods From January to March in 2022, from the follow-up data of 2019 from the Family Health Inquiry Survey of Rural Residents, the middle-aged and older adults (age≥45 years old) from resident families (living in the corresponding counties for more than one year) were selected as subjects (n=5 908) . The analysis was conducted with the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate as dependent variables, with sex, age, marital status, level of education, occupation, type of drinking water and per capita family income as independent variables. The concentration index was used to analyze the health equity of the middle-aged and older adults, and the centralized index decomposition method was used to analyze the contribution of various influencing factors to health inequality. Results The concentration indexes of two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Haiyuan County were 0.030 0, 0.002 9, 0.011 4 and 0.032 7, respectively, while those of two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Yanchi County were 0.000 4, -0.000 1, 0.037 4 and 0.037 4, respectively. The concentration index decomposition analysis showed that gender, age, level of education, occupation, type of drinking water and per capita family income are the main causes for health inequality among the middle-aged and older adults, among which age and per capita family income contribute more to health inequality. The contribution ratio of age to the two-week prevalence rate, hronic disease prevalence rate, two-week bedridden rate and two-week leaving rate in Haiyuan County were -11.92%, -152.57%, -27.76% and 7.80%, respectively. The contribution ratio of age to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate in Yanchi County were -334.79%, 1 117.94%, -45.45% and-25.44%, respectively. The contribution ratio of per capita family income to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Haiyuan County were 35.41%, -0.31%, 2.08% and 22.03%, respectively. The contribution ratio to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Yanchi County were 86.88%, -165.24%, 37.13% and 1.50%, respectively. Conclusion Overall, the health equity among the middle-aged and older adults in the pilot counties of the Ningxia Hui Autonomous Region is better but tilted towards those with higher incomes. Age contributes the most to health inequity among the middle-aged and older adults. The society should give higher priority to the middle-aged and older adults; Local primary health care institutions can increase the health awareness of the middle-aged and older adults by providing free health check-ups regularly and promoting health literacy to them. The health administration should adjust relevant health policies to better meet the health needs of the middle-aged and older adults and ultimately achieve health equity.

Background As population ageing accelerates and life expectancy increases, multimorbidity and disability pose challenges to health and social care systems worldwide. Although multimorbidity is closely related to disability, there is still a lack of research on the impact of multimorbidity on disability in rural middle-aged and elderly people. Objective To evaluate the influence of multimorbidity on disability in rural middle-aged and elderly people using the propensity-score matching (PSM) , providing a reference for formulating strategies for the management of multimorbidity and disability in this population. Methods The data of 11 088 rural middle-aged and elderly people (≥45 years old) were collected from the 2018 China Health and Retirement Longitudinal Study in March 2022, including demographics, chronic disease prevalence, and disability measured by activities of daily living (ADLs) , and instrumental activities of daily living (IADLs) . Participants were divided into multimorbidity and non-multimorbidity groups by the prevalence of multimorbidity (defined as having ≥2 chronic conditions) , and then matched using PSM with a 1∶1 ratio. Conditional Logistic regression model for paired binary data was used to assess the impact of multimorbidity on ADL disability and IADL disability. Results Of 11 088 ural middle-aged and elderly people with chronic diseases, 2 711 (24.45%) had ADL disability, 4 216 (38.02%) had IADL disability, and 7 673 (69.20%) were multimorbidity patients. The prevalence of ADL disability or IADL disability differed significantly by gender, age, marital status, education level, sleep duration, smoking, drinking, disability status, participation in social activities, and prevalence of multimorbidity (P

ObjectiveTo obtain the prevalence of sarcopenia in middle-aged and elderly people in Urumqi based on the 2020 updated based on the 2020 updated Consensus Report 2019 of Asian Working Group for Sarcopenia （AWGS2019）， and to further explore the association between sarcopenia and metabolic syndrome （MS）.MethodsA total of 1 438 middle-aged and elderly people （aged≥50 years） in Urumqi from July 2018 to January 2019 were selected as the research subjects. Data were collected by questionnaire survey， physical examination and laboratory test. Skeletal muscle mass，grip strength and 4 m walking speed were used to represent muscle mass， muscle strength and body function， respectively. Bioelectrical impedance analysis （BIA） was used to measure human body components. Based on the diagnostic criteria of sarcopenia recommended by AWGS2019， the prevalence of sarcopenia in people over 50 years old was obtained. Multivariate logistic regression model was used to explore the correlation between sarcopenia and MS in middle-aged and elderly people of different genders.ResultsThere were 194 patients with sarcopenia， with a prevalence of 13.49%. The prevalence was 15.56% in males and 12.12% in females. There was no significant difference in the prevalence of MS between male sarcopenia group （40.45%） and non-sarcopenia group （38.92%）， while the prevalence of MS in female sarcopenia group （39.04%） was higher than that in non-sarcopenia group （27.56%）. Multivariate logistic regression analysis showed that sarcopenia was a related factor of MS. Compared with non-sarcopenia， the risk of MS in male sarcopenia group was higher （OR=2.11，95%CI： 1.15‒3.88 ）.ConclusionSarcopenia increases the risk of MS in middle-aged and elderly people， with a greater risk in men. Fully understanding of sarcopenia is helpful to early identify high-risk groups of MS and prevent the occurrence of MS.

Abstract Background Dyslipidemia is a key factor causing cardio cerebrovascular diseases, and the total cholesterol (TC) is an important lipid indicator among them. Studies have shown that environmental factors have a strong association with TC levels. Previous studies only focused on the seasonal variation of TC level and the short-term effects of some environmental factors on TC level over time, and few studies explored the geographical distribution of TC level and quantified the impact of environmental factors in space. Methods Based on blood test data which was from China Health and Retirement Longitudinal Study (Charls) database, this study selected the TC level test data of middle-aged and elderly people in China in 2011 and 2015, and collected data from 665 meteorological stations and 1496 air pollutant monitoring stations in China. After pretreatment, the spatial distribution map of TC level was prepared and the regional statistics were made. GeoDetector and geographically weighted regression (GWR) were used to measure the relationship between environmental factors and TC level. Results The TC level of middle-aged and elderly in China was higher in females than in males, and higher in urban areas than in rural areas, showing a clustered distribution. The high values were mainly in South China, Southwest China and North China. Temperature, humidity, PM10 and PM2.5 were significant environmental factors affecting TC level of middle-aged and elderly people. The impact of pollutants was more severe in northern China, and TC level in southern China was mainly affected by meteorological factors. Conclusions There were gender and urban-rural differences in TC levels among the middle-aged and elderly population in China, showing aggregation in geographical distribution. Meteorological factors and air pollutants may be very important control factors, and their influencing mechanism needs further study.

Objective To evaluate the dietary quality with the dietary balance index (DBI＿16) and the association between dietary quality and bone mass among middle-aged and elderly people in Gansu Province so as to provide evidence for improving dietary quality and bone health status of Gansu population. Methods Based on the information of the type and quantity of food intake and the bone mass of middle-aged and elderly people aged 35 years and above collected by the Gansu Project in the Regional Ethnic Cohort Study in Northwest China, DBI＿16 was used to evaluate the intake level of cereals, vegetables, fruits, milk, beans, fish and shrimp, eggs and other foods, and the degree of inadequate, excessive and unbalanced dietary intake of the participants.Multiple linear regression was used to evaluate the associations of three component indexes of DBI＿16, high bound score (DBI＿HBS), low bound score (DBI＿LBS), diet quality distance (DBI＿DQD), and seven single indexes of DBI＿16 with bone mass.Results Analyses of the dietary and bone mass data of 11, 840 participants showed that 44.8% of participants consumed excessive amounts of cereals compared to the dietary recommendation. 96.3%, 90.6%, 90.1%, 71.9%, 95.1% and 60.3% of participants’ intake of vegetables, fruits, milk, soybeans, fish and shrimp, and eggs, respectively, were inadequate.47.7% participants consumed less than 10 types of food.2.3% participants’ DBI＿LBS levels were appropriate.54.7% participants’ DBI＿HBS levels were appropriate.Only 1.2% participants’ DBI＿DQD reached a balanced level.The bone mass level in the study population was（2.5±0.6)kg[（2.8±0.5)kg for men and（2.3±0.5)kg for women]. After adjusting for sociodemographic characteristics, lifestyle, total dietary energy intake and body mass index, DBI＿LBS and DBI＿DQD were negatively associated with bone mass[βand 95% CI was-0.002 01 (-0.003 62--0.000 40)and-0.001 76 (-0.003 09--0.000 43), respectively]. Conclusion Dietary intake imbalance is common among middle-aged and elderly people in Gansu Province, and the more severe the dietary intake imbalance, the lower the bone mass level. [ABSTRACT FROM AUTHOR]

(1) Background: With the aging demographic shift in society, there is a growing number of middle-aged and elderly individuals affected by metabolic syndrome (MetS), a risk factor contributing to all causes of mortality. Inflammation plays a crucial role in the development of MetS. This study aims to examine the correlation between MetS and pro-inflammatory diets in middle-aged and elderly individuals, utilizing the Dietary Inflammation Index (DII) as a measure. (2) Methods: Data were extracted from the 2007–2016 National Health and Nutrition Examination Survey (NHANES) database for individuals who were 45 years of age or older. The DII was determined for each participant through 24-h dietary recall interviews. The relationship between DII and MetS was assessed using binary logistic regression analysis, and the association between DII and MetS-related indicators was further explored through generalized linear model (GLM) and quantile regression analysis. (3) Results: A total of 3843 middle-aged and elderly individuals were included in the study. After controlling for confounding factors, the highest quartile of DII was associated with a higher risk of MetS (OR Q 4 : Q 1 = 1.339; 95% CI: 1.013, 1.769; p for trend = 0.018). The top DII quartile also increased the risk of reduced HDL-C (OR Q 4 : Q 1 = 1.499; 95% CI: 1.005, 2.234; p for trend = 0.048) and raised FG (OR Q 4 : Q 1 = 1.432; 95% CI: 1.095, 1.873; p for trend = 0.010) compared to the lowest DII quartile. The levels of DII were found to be positively correlated with BMI (β = 0.258, p = 0.001), FPG (β = 0.019, p = 0.049), TG (β = 2.043, p = 0.013), waistline (β = 0.580, p = 0.002), and negatively correlated with HDL-C (β = −0.672, p = 0.003). (4) Conclusions: In middle-aged and elderly individuals in the United States, a high DII score has been linked to the presence of MetS, low HDL-C, and hyperglycemia. Therefore, dietary recommendations for the middle-aged and elderly should focus on reducing the DII by choosing foods rich in antioxidants, dietary fiber, and unsaturated fatty acids. [ABSTRACT FROM AUTHOR]