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BACKGROUND: Low protein intake (LPI) has been suggested as a treatment for chronic kidney disease (CKD). However, protein intake is essential for bone health. METHODS: We studied the database of the National Health and Nutrition Examination Survey, 2005-2010. Basic variables, metabolic diseases, and bone density of different femoral areas were stratified into four subgroups according to different protein intake (DPI) (that is, 1.2 g/kg/day). RESULTS: Significant differences were found among all lumbar area bone mineral density (BMD) and T-scores (p 1.2 g/day/kg over L2 (relative risk (RR)=1.326, 95% confidence interval (CI)=1.062-1.656), subgroup >1.2 g/day/kg over L3 (RR = 1.31, 95%CI = 1.057-1.622), subgroup 1.2 g/day/kg over all L spines (RR = 0.333, 95%CI = 1.098-1.618). However, a higher risk of osteoporosis was observed only in the non-CKD group. There was an apparent trend of higher DPI coexisting with lower BMD and T scores in patients with CKD. For osteoporosis (reference:0.8-1.0 g/day/kg), lower (1.2 g/day/kg) was associated with higher risks in the non-CKD group, but not in the CKD group. CONCLUSIONS: In the CKD group, LPI for renal protection was safe without threatening L spine bone density and without causing a higher risk of osteoporosis.

Associations of total testosterone (T) and calculated free T with cardiovascular disease (CVD) remain poorly understood. Particularly how these associations vary according to race and ethnicity in a nationally representative sample of men. Data included 7058 men (≥20 years) from NHANES. CVD was defined as any reported diagnosis of heart failure (HF), coronary artery disease (CAD), myocardial infarction (MI), and stroke. Total T (ng/mL) was obtained among males who participated in the morning examination. Weighted multivariable-adjusted logistic regression models were conducted. We found associations of low T (OR = 1.57, 95% CI = 1.17-2.11), low calculated free T (OR = 1.53, 95% CI = 1.10-2.17), total T (Q1 vs Q5), and calculated free T (Q1 vs Q5) with CVD after adjusting for estradiol and SHBG. In disease specific analysis, low T increased prevalence of MI (OR = 1.72, 95% CI = 1.08-2.75) and HF (OR = 1.74, 95% CI = 1.08-2.82), but a continuous increment of total T reduced the prevalence of CAD. Similar inverse associations were identified among White and Mexican Americans, but not Blacks (OR = 0.93, 95% CI = 0.49-1.76). Low levels of T and calculated free T were associated with an increased prevalence of overall CVD and among White and Mexican Americans. Associations remained in the same direction with specific CVD outcomes in the overall population.

The appropriate use of human biomonitoring data to model population chemical exposures is challenging, especially for rapidly metabolized chemicals, such as agricultural chemicals. The objective of this study is to demonstrate a novel approach integrating model predicted dietary exposures and biomonitoring data to potentially inform regulatory risk assessments. We use lambda-cyhalothrin as a case study, and for the same representative U.S. population in the National Health and Nutrition Examination Survey (NHANES), an integrated exposure and pharmacokinetic model predicted exposures are calibrated to measurements of the urinary metabolite 3-phenoxybenzoic acid (3PBA), using an approximate Bayesian computing (ABC) methodology. We demonstrate that the correlation between modeled urinary 3PBA and the NHANES 3PBA measurements more than doubled as ABC thresholding narrowed the acceptable tolerance range for predicted versus observed urinary measurements. The median predicted urinary concentrations were closer to the median measured value using ABC than using current regulatory Monte Carlo methods.

BACKGROUND: Combining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective of this study is to examine dietary quality - using Healthy Eating Index (HEI - 2020) and its 13 components, among current, former, and never smokers, and particularly the impact of quitting and the duration of cessation on dietary habits. METHODS: A cross-sectional analysis of 31,569 adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 was conducted. Dietary quality was assessed using HEI-2020 scores, which were determined by NIH developed - simple HEI scoring algorithm per person. Smoking status was categorized into current, former, and never smokers, with further subdivisions for current (heavy/light smokers) and former smokers (duration post-cessation). Descriptive analysis and multiple regression models weighted to represent the US population were performed. RESULTS: The current smoking rate was 19.4%, with a higher prevalence in males (22.5%) than females (17.5%). Current smokers reported statistically significantly lower HEI total score than both former and never smokers. Former smokers exhibited HEI scores similar to those of never smokers. The adjusted HEI total scores for current, former, and never smokers were 49.2, 54.0, and 53.3, respectively, with a statistically significant difference (p  0.05, respectively). Compared to current smokers, former smokers tended to consume more beneficial foods (e.g., fruits, vegetables, greens and beans, whole grains, proteins, and fatty acids), while also consuming more sodium and less added sugar. CONCLUSIONS: Current smokers, particularly heavy smokers, exhibit poorer dietary habits than former and never smokers. The dietary quality of former smokers aligns with never smokers over time, highlighting the positive impact of smoking cessation on diet. This has implications for reducing chronic disease risks associated with poor diet and smoking.

Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity. The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated. A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P

Investment in health has been proposed as a mechanism to promote upward social mobility. Previous analyses have reported inconsistent estimates of the returns to investment in health in Mexico based on different models for different years. We aim to estimate returns for Mexico using data from four time points Adult height and labor income are drawn from the periodical national health and nutrition surveys-a group of relatively standardized surveys-that are representative of individuals living in the country in 2000, 2006, 2012 & 2018. These surveys collect anthropometric measurements and information on individuals labor income. We estimated Mincerian models separately for men and women using OLS, Heckman, instrumental variables, and Heckman with instrumental variables models. Our results indicate significant and positive returns to health for the four surveys, similar in magnitude across years for women and with variations for men. By 2018, returns to health were about 7.4% per additional centimeter in height for females and 9.3% for males. Investments in health and nutrition during childhood and adolescence that increase health capital-measured as adult height-may promote social mobility in Mexico and similar countries to the extent that these investments differentially increase health capital among the poor.

Multiple genes might interact to determine the age at onset of bipolar disorder. We investigated gene-gene interactions related to age at onset of bipolar disorder in the Korean population, using genome-wide association study (GWAS) data. The study population consisted of 303 patients with bipolar disorder. First, the top 1000 significant single-nucleotide polymorphisms (SNPs) associated with age at onset of bipolar disorder were selected through single SNP analysis by simple linear regression. Subsequently, the QMDR method was used to find gene-gene interactions. The best 10 SNPs from simple regression were located in chromosome 1, 2, 3, 10, 11, 14, 19, and 21. Only five SNPs were found in several genes, such as FOXN3 , KIAA1217 , OPCML , CAMSAP2 , and PTPRS. On QMDR analyses, five pairs of SNPs showed significant interactions with a CVC exceeding 1/5 in a two-locus model. The best interaction was found for the pair of rs60830549 and rs12952733 (CVC = 1/5, P < 1E−07). In three-locus models, four combinations of SNPs showed significant associations with age at onset, with a CVC of >1/5. The best three-locus combination was rs60830549, rs12952733, and rs12952733 (CVC = 2/5, P < 1E−6). The SNPs showing significant interactions were located in the KIAA1217 , RBFOX3 , SDK2 , CYP19A1 , NTM , SMYD3 , and RBFOX1 genes. Our analysis confirmed genetic interactions influencing the age of onset for bipolar disorder and identified several potential candidate genes. Further exploration of the functions of these promising genes, which may have multiple roles within the neuronal network, is necessary. • Genetic interactions are crucial for the sub-phenotype of psychiatric disorder. • Age at onset of bipolar disorder was influenced by gene-gene interactions. • The SNPs showing significant interactions were located in the KIAA1217 , RBFOX3 , SDK2 , CYP19A1 , NTM , SMYD3 , and RBFOX1 genes. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the association between alcohol consumption in adolescence and the risk of hypertension or prehypertension development in early adulthood. This cohort study included adolescent participants aged 12–18 years from the 2000–2011 China Health and Nutrition Survey. Cox proportional risk regression models were used to analyze the associations of the frequency of alcohol consumption, alcohol intake, and type of alcohol with the risk of developing hypertension or prehypertension. Restricted cubic spline analysis was used to assess the dose–response relationships for alcohol intake and their hazard ratios (HRs). A total of 1556 participants were included in the final analysis. Among the overall population, 448 (30.81%) and 35 (34.31%) participants developed hypertension or prehypertension, respectively. Compared with no alcohol consumption, alcohol consumption ≥ 2 times/week and consumption of ≥2 types of alcohol were associated with an increased risk of hypertension and prehypertension, with HRs of 1.97 (95% confidence interval [CI] 1.17–3.34; p = 0.011) and 1.77 (95% CI 1.01–3.09; p = 0.046), respectively. Alcohol intake of > 96 mL/week was associated with an increased risk of hypertension and prehypertension, with HRs of 2.09 (95% CI 1.12–3.90; p = 0.020) and 2.07 (95% CI 1.11–3.84; p = 0.021), respectively. The restricted cubic spline analysis showed that the risk of developing high blood pressure or prehypertension tends to increase with increasing alcohol consumption. Heavy alcohol consumption in adolescence increased the risk of developing hypertension and prehypertension in early adulthood. [ABSTRACT FROM AUTHOR]

Given the psychological aspects of sports nutrition, understanding one's athletic identity (AI) may improve targeted nutrition education. Therefore, the purpose of this study was to examine nutrition habits and AI among uninjured youth athletes. Athletic Identity Measurement Scale (AIMS) and custom Sports Nutrition Assessment for Consultation (SNAC) scores collected prospectively at local sporting events were retrospectively assessed via Mann–Whitney, Kruskal–Wallis, logistic regression, and ANCOVA tests (95% CI). Among 583 athletes (14.5 ± 2.1 years; 59.9% female), the total AIMS scores did not differ by sex (males 39.9 ± 7.2; females 39.3 ± 7.5; maximum 70). The Social Identity (p = 0.009) and Exclusivity (p = 0.001) subscores were higher in males, while the Negative Affectivity subscores were lower (p = 0.019). Females reported frequent associations between SNAC and AIMS, particularly Negative Affectivity, which was positively associated with stress fracture history (p = 0.001), meal-skipping (p = 0.026), and desiring nutrition knowledge (p = 0.017). Males receiving weight recommendations reported higher Negative Affectivity subscores (p = 0.003), and higher total AIMS scores were observed in males with fatigue history (p = 0.004) and a desire for nutrition knowledge (p = 0.012). Fatigue and stress fracture history predominated in high-AI males and females, respectively, suggesting that poor sports nutrition may present differently by sex. As suboptimal nutrition was frequently related to high Negative Affectivity subscores, these habits may increase following poor sports performance. [ABSTRACT FROM AUTHOR]

Background: Amino acids are crucial for nutrition and metabolism, regulating metabolic pathways and activities vital to organismal health and stability. Glycine and histidine act as potent antioxidants and anti-inflammatory agents; however, limited knowledge exists regarding the associations between these amino acids and hyperlipidemia and hypertension. The purpose of this study is to investigate the relationship between dietary glycine and histidine, and hyperlipidemia and hypertension. Methods: This population-based cross-sectional study evaluated the influence of dietary glycine and histidine, as well as their combined effect, on hyperlipidemia and hypertension in Chinese adults participating in the Nutrition Health Atlas Project (NHAP). General characteristics were acquired using a verified Internet-based Dietary Questionnaire for the Chinese. Binary logistic regression, along with gender, age groups, and median energy intake subgroup analyses, was employed to investigate the associations between dietary glycine and histidine and hyperlipidemia and hypertension. A sensitivity analysis was conducted to assess the impact of excluding individuals who smoke and consume alcohol on the results. Results: Based on the study's findings, 418 out of 1091 cases had hyperlipidemia, whereas 673 had hypertension. A significant inverse relationship was found between dietary glycine, histidine, and glycine + histidine and hyperlipidemia and hypertension. Compared with the 1st and 2nd tertiles, the multivariable-adjusted odd ratios (ORs) (95% confidence intervals) (CIs) of the 3rd tertile of dietary glycine for hyperlipidemia and hypertension were 0.64 (0.49–0.84) (p < 0.01) and 0.70 (0.56–0.88) (p < 0.001); histidine was 0.63 (0.49–0.82) (p < 0.01) and 0.80 (0.64–0.99) (p < 0.01); and glycine + histidine was 0.64 (0.49–0.83) (p < 0.01) and 0.74 (0.59–0.92) (p < 0.001), respectively. High glycine and high histidine (HGHH) intake were negatively associated with hyperlipidemia and hypertension OR (95% CIs) were: 0.71 (0.58–0.88) (p < 0.01) and 0.73 (0.61–0.87) (p < 0.01), respectively. Conclusions: Dietary glycine and histidine, as well as their HGHH group, revealed an inverse relationship with hyperlipidemia and hypertension. Further investigations are needed to validate these findings. [ABSTRACT FROM AUTHOR]

AbstractDietary exposure to a food chemical (e.g. contaminant, nutrient, or other natural constituent) is a function of the concentration of the chemical in foods and the quantity of each food consumed. Exposures to food chemicals can be estimated using intake data from What We Eat in America (WWEIA), the food consumption survey portion of the National Health and Nutrition Examination Survey (NHANES). To estimate exposures to chemicals in foods consumed by NHANES/WWEIA respondents, the consumption data must be mapped to chemical concentration data on the same or similar foods. However, food chemical data are generally not available on all the foods and food mixtures that are reported in NHANES/WWEIA. To address this, we developed the FDA Food Disaggregation Database (FDA-FDD), a ‘recipe’ database with estimates of ingredient percentages. FDA-FDD allows mapping to food chemical data based on ingredients in NHANES/WWEIA foods rather than on food mixtures, resulting in more accurate exposure estimates. Using FDA-FDD, FDA mapped over 11,000 NHANES/WWEIA foods to FDA’s Total Diet Study (TDS) foods. FDA-FDD is available as part of a publicly available interactive application that also allows access to the TDS mapping. [ABSTRACT FROM AUTHOR]

Background: With rising obesity rates in Western societies, analyzing changes in dietary patterns is paramount. While nutritional surveys have been informative, traditional cookbooks have historically shed light on national cuisines and its changes. Despite the growing popularity of online platforms for food information, cookbooks might still reflect prevalent dietary trends and the diets people follow. This study examined (1) the changes in nutritional content and food group usage in the best-selling cookbooks from 2008 to 2018, and (2) the correlation between the food groups in these cookbooks and dietary patterns (inferred from household purchases) over the same timeframe. Methods: An exploratory ecological study was conducted on 20 main course recipes of each of the five best-selling cookbooks in Flanders annually between 2008 and 2018. Trends in macronutrients and food group usage in these recipes were analyzed using generalized linear models. Additionally, these trends were compared to household purchase data in Flanders using correlation matrices. Results: Our results reveal a rising trend towards the use of plant-based ingredients and meat alternatives in cookbooks over the period 2008–2018. There was an increase in the usage of vegetables, nuts & seeds, and cheese. Conversely, there was a decline in the usage of meat, sugar & sweeteners, alcohol, and dairy (all p-values < 0.05). In terms of macronutrient content, there was an upswing in carbohydrate, fibre, and sugar levels, while the total fat content showed a decrease (all p-values < 0.05). The levels of protein and saturated fat remained consistent over time. Notably, shifts in plant-based and animal-based food group preferences in popular cookbook recipes align with the trends seen in actual household purchases of these food groups (all p-values < 0.05). Conclusion: These findings indicate that cookbook content evolves over time, potentially reflecting shifts in population dietary patterns. Future research is needed to determine (Buisman ME, Jonkman J. Dietary trends from 1950 to 2010: a Dutch cookbook analysis. J Nutr Sci [Internet]. 2019 ed [cited 2022 Apr 19];8. https://www.cambridge.org/core/journals/journal-of-nutritional-science/article/dietary-trends-from-1950-to-2010-a-dutch-cookbook-analysis/AB281ADE0F09FF8F518B8AC4A2A5BEA8#supplementary-materials) any causative link between cookbooks and dietary habits, and (Ashwell M, Barlow S, Gibson S, Harris C. National Diet and Nutrition Surveys: the British experience. Public Health Nutr. 2006;9(4):523–30.) the potential for cookbooks to aid in health promotion. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Stress urinary incontinence (SUI) may be associated with cardiovascular disease. Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH), has been investigated for its association with SUI in women.The study adopted a cross‐sectional design with national scope, incorporating 9332 women aged 20 and above, selected from the National Health and Nutrition Examination Survey dataset from 2005 to 2018. The LE8 metric, which varies from 0 to 100, was evaluated based on the criteria set by the American Heart Association. SUI was determined based on self‐report. To evaluate these correlations, we employed models with multivariable logistic variables and a restricted cubic spline.In the cross‐sectional study, a total of 9332 participants were included (weighted average age, 52.23 years), and 4274 had SUI (weighted percentage, 48.64%). Considering potential confounders, it was found that higher LE8 scores were associated with lower odds of SUI (odds ratio [OR] for each 10‐point increase was 0.83; 95% confidence interval [CI], 0.80–0.87). Compared to participants with lower LE8 scores, those with higher LE8 scores had a 57% lower probability of developing SUI. There was a statistically significant association between LE8 score and SUI among participants who were middle‐aged, non‐Hispanic white, had higher levels of education and income, and were living with a partner.According to this study, there was an association between increase in Life's Essential 8 and reduction in SUI risk. Therefore, promoting optimal CVH may associate with reducing SUI in women. [ABSTRACT FROM AUTHOR]

Socioeconomic status (SES) has a considerable impact on cardiovascular health (CVH), which may differ by sex. We aimed to investigate sex-specific socioeconomic disparities in CVH among 31,141 individuals aged 25–64 years who participated in the cross-sectional 2007–2017 Korea National Health and Nutrition Survey (KNHANES) and the Life's Simple 7 metrics were used to define ideal CVH. Latent class analysis was used to estimate overall SES patterns. Logistic regression models were used to estimate sex-specific odds ratios (ORs) and 95% confidence interval (95% CI) for the likelihood of ideal CVH across SES classes, with the highest SES as the reference group. Four SES classes were identified: (1) low class with low education and material property (2.4%), (2) lower-medium class (10.1%) and (3) higher-medium class (43.7%) with increasing material affluence, and (4) high class with highest education and income (43.8%). Lower SES was associated with decreased ideal CVH among women; compared to their high SES counterparts, women with lowest SES were least likely to achieve ideal overall CVH (OR: 0.55, 95%CI: 0.43–0.71). Similar SES gradients in ideal overall CVH for men were also observed but it was less clear (OR (95%CI) for lowest SES: 0.83, 0.51–1.34). Low SES was associated with poorer achievement of ideal CVH with some sex-heterogeneities. Interventions that equalize the distribution of power and resources and targeted sex-specific approaches to empower low socioeconomic subgroups are warranted to prevent the transition from ideal to suboptimal cardiovascular health and to close socioeconomic disparities in CVH among Korean adults. [ABSTRACT FROM AUTHOR]

The consumption of 100% orange juice (OJ) has been associated with nutrient adequacy and better diet quality. To date, there are few analyses exploring 100% OJ consumption patterns across populations, with no data from Brazil. We aimed to explore the associations between 100% OJ consumption, sociodemographic factors, and nutrient intake in a representative sample of the Brazilian general population aged 10 years or older. Data were obtained from the National Dietary Survey 2017–2018, a cross-sectional study including data on individual food intake of 46,164 subjects aged ≥10 years collected using two 24-h dietary recalls. 100% OJ was consumed by 11% of the population, with a mean intake of 43.0 ml/d. Males were more frequent consumers compared to females, and the percentage of consumers increased with education and income. 100% OJ consumption was associated with higher intakes of energy, vitamin C, folate, calcium, magnesium, potassium, polyphenols, and carotenoids. There is no significant difference in fiber intake between consumers and non-consumers. 100% OJ consumers had a higher percentage of the population meeting the Estimated Average Requirement for vitamin A, vitamin C, vitamin D, folate, calcium, and magnesium. Our results suggest that 100% OJ could be a component of a healthy diet, helping individuals to achieve nutrient recommendations. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the dietary consumption patterns of traditional Chinese medicine (TCM) among the population in Guangdong province. Employing a cross‐sectional design, the survey was conducted from 2019 to 2021 to examine the inclusion of TCM in the diet of participants in Guangdong province. Information regarding consumption of TCM during the preceding 12 months was collected using a food frequency questionnaire. The participant cohort comprised a total of 3031 participants, consisting of 1081 Cantonese, 967 Hakka, and 983 Teochew individuals. The survey included 42 TCM, with consumption rates ranging from 2.6% to 47.3%. The top five TCM comprised Citri Reticulatae Pericarpium (47.3%), Lonicerae Japonicae Flos (47.0%), Codonopsis Radix (46.4%), Polygonati Odorati Rhizoma (43.1%), and Siraitiae Fructus (41.5%), along with Panacis Quinquefolii Radix (41.5%). These TCM possess recognized therapeutic properties within TCM for clearing heat, drying dampness, and detoxification. Within the top decile of 10 TCM, only Lonicerae Japonicae Flos was ubiquitous across all three sub‐populations. Nonetheless, 11 TCM from the top 20 and 17 TCM from the top 30 overlapped among the three sub‐populations. The study revealed substantial variability in the consumption rates of different TCM. Notably, those with traditional Chinese medicine effects of clearing heat, drying dampness, and detoxification exhibited higher consumption rates. Disparities in the consumption rates of these TCM were noted among the Cantonese, Hakka, and Teochew populations. [ABSTRACT FROM AUTHOR]

Background & aims: Obesity has been linked to various detrimental health consequences. While there is established evidence of a negative correlation between seafood consumption and obesity in adults, the current research on the association between seafood intake in childhood/adolescence and the risk of obesity is lacking. Our aim was to evaluate the association between seafood intake in childhood/adolescence and the risk of obesity in a Chinese nationwide cohort. Methods: We utilized data from the China Health and Nutrition Survey (CHNS) from the year of 1997 to 2015. Seafood consumption was evaluated through 3-day 24-hour recalls. In our study, overweight/obesity status was determined based on the Chinese Criteria of Overweight and Obesity in School-age Children and Adolescents (WS/T 586–2018), while abdominal obesity status was determined according to the Chinese Criteria of Waist Circumference Screening Threshold among Children and Adolescents (WS/T 611–2018). Results: During an average follow-up of 7.9 years, 404 cases developed overweight/obesity among 2206 participants in the seafood-overweight/obesity analysis, while 381 cases developed abdominal obesity among 2256 participants in the seafood-abdominal-obesity analysis. The high-consumer group was associated with 35% lower risk of overweight/obesity risk and 26% lower risk of abdominal obesity after fully adjusting for sociodemographic and lifestyle factors, compared with the non-consumer group. Considering different cooking methods, boiled seafood consumption was associated with 43% lower risk of overweight/obesity and 23% lower risk of abdominal obesity in the fully adjusted model, while stir-fried seafood did not demonstrate a statistical significance. Conclusion: Higher intake of seafood in childhood/adolescents, particularly in a boiled way, was associated with lower obesity risk. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a significant public health problem. The burden of CKD in children and adolescents in India is not well described. We used data from the recent Comprehensive National Nutrition Survey (CNNS) to estimate the prevalence of impaired kidney function (IKF) and its determinants in children and adolescents between the ages of 5 and 19. Methods: CNNS 2016–18 adopted a multi-stage sampling design using probability proportional to size sampling procedure after geographical stratification of urban and rural areas. Serum creatinine was tested once in 24,690 children and adolescents aged 5–19 years. The estimated glomerular filtration rate (eGFR) was derived using the revised Schwartz equation. The eGFR value below 60 ml/min/1.73 m2 is defined as IKF. Bivariate analysis was done to depict the weighted prevalence, and multivariable logistic regression examined the predictors of IKF. Results: The mean eGFR in the study population was 113.3 + 41.4 mL/min/1.73 m2. The overall prevalence of IKF was 4.9%. The prevalence in the 5–9, 10–14, and 15–19 year age groups was 5.6%, 3.4% and 5.2%, respectively. Regression analysis showed age, rural residence, non-reserved social caste, less educated mothers, Islam religion, children with severe stunting or being overweight/obese, and residence in Southern India to be predictors of IKF. Conclusions: The prevalence of IKF among children and adolescents in India is high compared to available global estimates. In the absence of repeated eGFR-based estimates, these nationally representative estimates are intriguing and call for further assessment of socio-demographic disparities, genetics, and risk behaviours to have better clinical insights and public health preparedness. [ABSTRACT FROM AUTHOR]

Objective. To update the type 2 diabetes (T2D) prevalence, and to estimate the cascades of screening and care for T2D in the Mexican adult population. Materials and methods. We used information from the National Health and Nutrition Survey 2023. We estimated the cascade of screening using the eligible population according to NOM-015-SSA2-2010 and the T2D care cascade using diagnosed cases. Results. The prevalence of T2D was 18.4% (12.4% diagnosed and 6.0% undiagnosed); 83% of the adult population without a T2D diagnosis had risk factors that made them eligible for blood screening; from them, 27.7% were screened in the past year (goal 33.3%). From T2D cases, 72.8% visited the doctor at least once in the last year, 92.8% were under pharmacological treatment, 77.9% used treatment regularly and 25.8% had glycemic control. Patients that completed the three steps of care (follow-up, treatment and regular treatment) achieved slightly better glycemic control (34.4%). Conclusion. Mexico faces important challenges to guarantee screening, care and control of T2D. We propose some actions to improve the detection and control of T2D based on the evidence generated through screening and care cascades. [ABSTRACT FROM AUTHOR]

Objective. To analyze water insecurity (WI), water supply frequency (WSF), and food insecurity (FI) in Mexican households, address their determinants, and propose recommendations for public policy. Materials and methods. Data from 28 500 households from the National Health and Nutrition Survey (Ensanut Continua 2020-2023) were analyzed. Validated experience scales such as HWISE and ELCSA were applied to measure WI and FI, as well as an indicator of the frequency of water supply, according to some determinants. Results. 16% of Mexican households experience WI and 22% suffer from moderate and severe FI. Only 34.7% receive water 24 hours a day, every day. The determinants of households most affected by WI, FI and in WSF, are poor welfare conditions, indigenous people and when WI and FI are found together in households. Conclusions. It is imperative to accelerate the implementation and improve the coverage of actions that positively impact access and availability of water and food for vulnerable people. [ABSTRACT FROM AUTHOR]

Objective. Estimate breastfeeding gaps in Mexico to achieve the 2030 global nutrition goals and provide public policy recommendations. Materials and methods. Data from women 12-59 years old and their children <24 months was analyzed using the National Health and Nutrition Survey (Ensanut, in Spanish) 2021 to 2023 to calculate breastfeeding indicators. The gaps to achieve the 2030 breastfeeding goals were estimated through comparison with national trends, considering the effectiveness of interventions in contexts similar to Mexico. Results. The prevalence of exclusive breastfeeding (EBF) in children <6 months is 34.2% and 43% for continued breastfeeding at two years. Breastfeeding prevalence is lower among women with lower parity and with paid employment, and higher among women with a low Well-being Conditions Index at the household level and those who received previous information about breastfeeding during pregnancy or in consultation. With the current trend, it is estimated 42.5% of EBF by 2030. The 2030 global nutrition goal of 70% EBF will only be achieved if health and community personnel are trained to provide breastfeeding counseling, if the Baby-Friendly Hospital Initiative is strength ened, if there is compliance with the International Code of Marketing of Breastmilk Substitutes, and if paid maternity leave is extended in Mexico. Conclusions. It is necessary to implement policies and actions from different sectors that facilitate breastfeeding to achieve 2030 global nutrition goals. [ABSTRACT FROM AUTHOR]

Objective. To analyze the evolution of the sexual and reproductive health indicators of the National Strategy for the Prevention of Adolescent Pregnancy (Enapea, in Spanish) in 2018-19 and 2021-23, and to contrast progress against 2030 targets. Materials and methods. We used the National Health and Nutrition Surveys (Ensanut, in Spanish) 2018-19 (n=14 117) and Ensanut Continua 2021-23 (n=7 505) to estimate the eleven Enapea indicators. Using the difference in proportions test, we analyzed these indicators' progress, regression, or stagnation between 2018-19 and 2021-23. Results. Of the eleven indicators examined, three related to pregnancy and condom knowledge improved, and two related to consistent use of modern contraception and use in the last intercourse worsened. Conclusions. Given that Covid-19 may have slowed the progress of Enapea, it is essential to continue strengthening comprehensive sexuality education; training and sensitizing health personnel; and increasing the coverage and provision of adolescent-friendly services. [ABSTRACT FROM AUTHOR]

Objective. Describe the prevalence of obesity in adults from the Continuous National Health and Nutrition Survey 2020-2023 (Ensanut 2020-2023), its main sociodemographic characteristics, its association with chronic diseases, risk factors and the consumption of industrialized energetic beverages (IEB), as well as trends in the last 23 years, to contribute to the generation of evidence for the design of public health policies. Materials and methods. Information from 32 889 participants was analyzed to characterize the Mexican adult population by body mass index (BMI) groups and stratified by sociodemographic variables. Logistic regression models were used to estimate the associations of these groups with the variables of interest. The trend of BMI groups in the last six national surveys (2000-2023) was explored. Results. The prevalence of obesity in adults was 37.1% (41.0% women, 33.0% men). The percentage of energy coming from EIB was twice as high in men as in women (6.8 vs. 3.3%). Men in the highest quartile of percentage of energy coming from EIB were 2.29 times more likely to have obesity (p<0.05). There was a continuous and significant increase in the prevalence of obesity in the period 2000-2012, but between 2016-2023 no significant differences were observed (p>0.05). Conclusions. The national prevalence of obesity in adults showed an increase of 41.7% in the period 2000-2016. Starting in 2016, there was a stabilization of the trend. High EIB consumption increases the possibility of obesity. Interventions with a comprehensive and multisystemic vision are required that allow the prevention and control of obesity. [ABSTRACT FROM AUTHOR]

Objective. To analyze the trends of malnutrition in children under five years of age in Mexico from 1988 to 2023 and to discuss the possible causes of the observed trends. Materials and methods. Information about nutritional status and sociodemographic variables from 5 987 children under five years of age from the National Health and Nutrition Surveys during the period 2020-2023 was analyzed and compared with the results of previous surveys. Results. The prevalence of underweight, stunting, wasting, and overweight was 3.9%, 13.9%, 1.2%, and 7.7% in 2020-2023. The highest percentages of stunting were observed in indigenous vs. non-indigenous households (27.4%) (p>0.10), with severe food insecurity vs. food security (20.7%) (p=0.079), quintiles of very low vs. high well-being conditions (20.8%), and rural vs. urban areas (16.9%) (p>0.10). Only 37.4% of households with children under five years of age are beneficiaries of one or more social programs. Conclusions. Malnutrition plateaued in 2012 and overweight has increased. The situation of poverty in households with children under five years old, the increase in the complexity of Prospera and the reduction in funding per beneficiary between 2012-2018, and since 2018 the lack of targeted programs and specific transfers to households with children under five years old, and the increase in the absence of basic health services, among others, could explain this situation. [ABSTRACT FROM AUTHOR]

Objective. To describe the magnitude of overweight and obesity (OW+OB) in school-age children and adolescents (5-19y) in Mexico, as well as its association with the consumption of fruits and vegetables (F+V) and added sugars. Materials and methods. The prevalence of OW+OB was estimated in 15 109 schoolchildren and adolescents from the National Health and Nutrition Surveys (Ensanut, in Spanish) from 2020 to 2023, according to the World Health Organization growth standards. The consumption of energy from added sugar and F+V consumption, were estimated in a subsample (n=4 014). The association between energy consumption from added sugars (as a percentage) and F+V consumption with OW+OB was analysed using logistic regression models. Results. The prevalence of OW+OB was 36.5% in schoolchildren and 40.4% in adolescents. The median percentage of energy consumption from sugars was 12.6%, and the median F+V consumption was 200 g/d. The probability of OW+OB decreased as F+V consumption increased in children with a parent with normal body mass index. The probability of OW+OB increased with a higher percentage of energy from added sugars. Conclusions. In Mexican population aged 5 to 19 years, added sugar consumption is high, while F+V consumption is low, these conditions are related with the high prevalence of OW+OB. Interventions to stop that situation are needed. [ABSTRACT FROM AUTHOR]

Background/Aims: Previous studies have shown that diet and physical activity can influence constipation. However, the combined effect of diet and physical activity on constipation remains unclear. Methods: Constipation was defined based on stool consistency and frequency, while overall diet quality was assessed using Healthy Eating Index (HEI)-2015 scores. Participants were categorized into low (metabolic equivalent [MET]-min/wk < 500) and high physical activity groups (MET-min/wk = 500). The association between diet and constipation across physical activity groups was analyzed using survey logistic regression and restricted cubic splines. Results: Higher HEI-2015 scores were associated with reduced constipation risk in the high physical activity group when constipation was defined by stool consistency (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97-0.99). However, in the low physical activity group, increased HEI-2015 scores did not significantly affect constipation risk (OR, 1.01; 95% CI, 0.97-1.05). Similar results were found when constipation was defined based on stool frequency. In the high physical activity group, increased HEI-2015 scores were significantly associated with a reduced constipation risk (OR, 0.96; 95% CI, 0.94-0.98). Conversely, in the low physical activity group, increased HEI-2015 scores did not affect the risk of constipation (OR, 0.96; 95% CI, 0.90-1.03). Conclusions: Our findings suggest that a higher HEI-2015 score is negatively associated with constipation among individuals with high physical activity levels but not among those with low physical activity levels. This association was consistent when different definitions of constipation were used. These results highlight the importance of combining healthy diet with regular physical activity to alleviate constipation. [ABSTRACT FROM AUTHOR]

Lead and its compounds can have cumulative harmful effects on the nervous, cardiovascular, and other systems, and especially affect the brain development of children. We collected 4918 samples from 15 food categories in 11 districts of Guangzhou, China, from 2017 to 2022, to investigate the extent of lead contamination in commercial foods and assess the health risk from dietary lead intake of the residents. Lead was measured in the samples using inductively coupled plasma mass spectrometry. Dietary exposure to lead was calculated based on the food consumption survey of Guangzhou residents in 2011, and the health risk of the population was evaluated using the margin of exposure (MOE) method. Lead was detected in 76.5% of the overall samples, with an average lead content of 29.4 µg kg−1. The highest lead level was found in bivalves. The mean daily dietary lead intakes were as follows: 0.44, 0.34, 0.25, and 0.28 µg kg−1 body weight (bw) day−1 for groups aged 3–6, 7–17, 18–59, and ≥ 60 years, respectively. Rice and rice products, leafy vegetables, and wheat flour and wheat products were identified as the primary sources of dietary lead exposure, accounting for 73.1%. The MOE values demonstrated the following tendency: younger age groups had lower MOEs, and 95% confidence ranges for the groups aged 3–6 and 7–17 began at 0.6 and 0.7, respectively, indicating the potential health risk of children, while those for other age groups were all above 1.0. Continued efforts are needed to reduce dietary lead exposure in Guangzhou. [ABSTRACT FROM AUTHOR]

The European Commission asked EFSA for a risk assessment on small organoarsenic species in food. For monomethylarsonic acid MMA(V), decreased body weight resulting from diarrhoea in rats was identified as the critical endpoint and a BMDL10 of 18.2 mg MMA(V)/kg body weight (bw) per day (equivalent to 9.7 mg As/kg bw per day) was calculated as a reference point (RP). For dimethylarsinic acid DMA(V), increased incidence in urinary bladder tumours in rats was identified as the critical endpoint. A BMDL10 of 1.1 mg DMA(V)/kg bw per day (equivalent to 0.6 mg As/kg bw per day) was calculated as an RP. For other small organoarsenic species, the toxicological data are insufficient to identify critical effects and RPs, and they could not be included in the risk assessment. For both MMA(V) and DMA(V), the toxicological database is incomplete and a margin of exposure (MOE) approach was applied for risk characterisation. The highest chronic dietary exposure to DMA(V) was estimated in 'Toddlers', with rice and fish meat as the main contributors across population groups. For MMA(V), the highest chronic dietary exposures were estimated for high consumers of fish meat and processed/preserved fish in 'Infants' and 'Elderly' age class, respectively. For MMA(V), an MOE of ≥ 500 was identified not to raise a health concern. For MMA(V), all MOEs were well above 500 for average and high consumers and thus do not raise a health concern. For DMA(V), an MOE of 10,000 was identified as of low health concern as it is genotoxic and carcinogenic, although the mechanisms of genotoxicity and its role in carcinogenicity of DMA(V) are not fully elucidated. For DMA(V), MOEs were below 10,000 in many cases across dietary surveys and age groups, in particular for some 95th percentile exposures. The Panel considers that this would raise a health concern. [ABSTRACT FROM AUTHOR]

Background and Objectives: If the proportion of calcium intake over a whole day is related to the risk of cognitive impairment in adults is still largely unknown. This research aimed to examine the relation of dietary calcium intake at dinner versus breakfast with the risk of cognitive impairment by using data from the China Health and Nutrition Survey (CHNS). Methods and Study Design: A total of 2,099 participants (including 668 cognitive impairment) in the CHNS (1997–2006) were included. The participants were categorized into 5 groups in accordance with the ratio of dietary calcium intake at dinner and breakfast (Δ = dinner/breakfast). After adjustment was conducted for a series of confounding factors, Cox hazard regression modelling was performed to discuss the relation of Δ with cognitive impairment. Dietary substitution models were used to explore the changes in cognitive impairment risk when a 5% dietary calcium intake at dinner was replaced with dietary calcium intake at breakfast. Results: Participants in the highest distribution of Δ showed a greater susceptibility to cognitive impairment than those in the lowest quintile, with an adjusted hazard ratio of cognitive impairment of 1.38 (95% CI: 1.08–1.76). When maintaining total calcium intake, substituting 5% of dietary calcium intake at dinner with calcium intake at breakfast was related to an 8% decrease in the risk of cognitive impairment. Conclusions: Higher dietary calcium intake at dinner was associated with an increased risk of cognitive impairment, emphasizing the importance of appropriately distributing dietary calcium intake between breakfast and dinner. [ABSTRACT FROM AUTHOR]

Some healthy lifestyle components have been linked with sleep disordered breathing (SDB), yet little is known about the relationship between comprehensive lifestyle factors and SDB. This study aimed to examine the healthy lifestyle with SDB in community-dwelling adults. We conducted a cross-sectional analysis of the Suzhou Food Consumption and Health Survey in China between 2018 and 2020. The healthy lifestyle index (HLI) was created by combining smoking, alcohol drinking, diet, physical activity, and body mass index (BMI). Its association with SDB was assessed by multiple logistic regression analysis. Subgroup analysis and sensitivity analysis were conducted to assess the robustness of our results. The final analysis included 3788 participants (2859 without SDB and 929 with SDB). In multivariable-adjusted analyses, non-smoking (OR: 0.58, 95 % CI: 0.47–0.71), non-drinking (OR: 0.55, 95 % CI: 0.45–0.68), healthy diet (OR: 0.79, 95 % CI: 0.65–0.95), and healthy BMI (OR: 0.72, 95 % CI: 0.6–0.86) were associated with SDB. Compared with participants with HLI score of 0–1, participants with HLI score of 2, 3, 4, and 5 had OR of 0.68 (95 % CI: 0.51–0.91), 0.49 (95 % CI: 0.37–0.64), 0.29 (95 % CI: 0.21–0.38), and 0.22 (95 % CI: 0.15–0.33), respectively, after adjustment for confounding factors (P -trend<0.001). An inverse dose-response relationship between HLI and SDB was also observed. The association was similar in subgroups stratified by sex, marital status, diabetes and dyslipidemia. A higher score of HLI was associated with reduced odds of SDB in Chinese adults. Our findings suggest the potential of addressing five modifiable lifestyle factors for the prevention of SDB. • There was an inverse dose-response association between healthy lifestyle index (HLI) and sleep disordered breathing (SDB). • No smoking, no alcohol consumption, healthy diet, and healthy BMI were protective factors for SDB. • The inverse association between HLI and SDB was independent of multiple confounders. [ABSTRACT FROM AUTHOR]

• Only 27% patients with Non-Alcoholic Fatty Liver Disease (NFALD) received statins. • Statin therapy was not associated with elevated liver enzyme levels. • ALT, total cholesterol, and LDL were significantly lower in statin users. • Findings demonstrate statin use in patients with NAFLD can reduce CVD risks. • Findings were generalized to the US population. Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease (CVD). Statins are recommended for treatment of dyslipidemia to reduce the overall cardiovascular risk in patients with NAFLD. However, statin treatment was underutilized and the effect of statins on liver enzymes remained unclear in this patient population. This study aimed to provide real-world evidence of the safety and effect of statin use in patients with NAFLD. We conducted a cross-sectional survey study of adults with NAFLD using pooled data from the US NHANES database 2009–2018. NAFLD was defined by Fatty Liver Index (FLI) ≥ 60 and United States Fatty Liver Index (USFLI) ≥ 30. Multivariate regression analyses adjusted for baseline clinical and demographic characteristics were performed to compare the liver enzymes and lipid profile between statin and non-statin users. The study included 2,533 adults with NAFLD, representing 22.6 million individuals in the US, with 27% receiving statin treatment between 2009 and 2018. The mean differences of liver enzymes for AST, ALT, ALP, and GGT between statin and non-statin users were -0.86 (p=0.539), -3.49 (p=0.042), -0.25 (p=0.913), and 0.57 (p=0.901), respectively. In individuals with NAFLD and dyslipidemia, total cholesterol and LDL levels were significantly lower in statin users compared to non-statin users (mean difference, -28.9; p<0.001 and -27.7; p<0.001). The use of statins was not associated with elevated liver enzymes in patients with NAFLD. Significantly lower levels of ALT, total cholesterol, and LDL were observed in statin users compared to non-statin users. [ABSTRACT FROM AUTHOR]

Chewing gum (especially sugar-free gum) has been linked to improved oral health, however there is an absence of observational research using nationally-representative data in the United States. We sought to examine the factors associated with chewing gum and its relationship with the oral health status of U.S. adults. Cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2013–2018 cycles were used in these analyses. Primary outcomes were the odds of having gum disease, treatment for gum disease, ever being told of bone loss around teeth, root caries, caries, and restoration. Unadjusted and multivariate logistic regression models were used to investigate the relationship of chewing gum use with demographic/lifestyle factors and the oral health status of participants. 2.40% (n = 365) of adults were users of chewing gum and the average among users was 5.20 ± 0.40 g/d. Users of chewing gum were more likely to be female, younger in age, and non-Hispanic Black or Hispanic. Self-reported chewing gum use did not affect the oral health status of U.S. adults (OR: 1.10, 95% CI: 0.42–2.88 for gum disease; OR: 1.34, 95% CI: 0.64–2.81 for treatment for gum disease; OR: 0.56, 95% CI: 0.27–1.17 for bone loss around teeth; OR: 1.01, 95% CI: 0.32–3.12 for root caries; OR: 0.96, 95% CI: 0.54–1.69 for caries), except for restoration (OR: 3.54, 95% CI: 1.78–7.06), but was associated with improved diet quality (OR: 1.86, 95% CI: 1.11–3.12 for a healthy eating index (HEI) of 51–59; OR: 1.96, 95% CI: 1.08–3.56 for HEI of 60–93); and decreased intakes of snacks (OR: 1.64, 1.01–2.69), and added sugars. Future observational studies that more accurately capture chewing gum usage are needed, as these analyses have several limitations. [ABSTRACT FROM AUTHOR]

BackgroundObservational studies investigating associations between cannabis use and blood pressure (BP)/hypertension are inconsistent.MethodsCross-sectional data from the National Health and Nutrition Examination Survey (NHANES) were analyzed for five 2-year cycles between 2009 and 2018 representing 9,783 middle-aged adults (35-59 years). Hypertension was defined as systolic BP (SBP) ≥130, diastolic BP (DBP) ≥80, or a BP medication. Sample-weighted multivariable logistic regression models were used to assess associations between cannabis use and BP and hypertension.ResultsOne quarter of respondents (n = 2,228) reported a history of monthly cannabis use for more than 1 year, which was consistent over the study period (P for trend = 0.75). Approximately 48% (n = 4,831) met the definition of hypertension. While a significant positive trend was seen over time for mean SBP and DBP (P =

Mechanistic research suggests using Cannabis sativa L. (cannabis or marijuana) may increase the risk of cardiometabolic disease, but observational studies investigating associations between cannabis use and myocardial infarction (MI) have reported inconsistent results. Cross-sectional National Health and Nutrition Examination Survey data from five 2-year cycles between 2009 and 2018 and representing 9,769 middle-aged adults (35 to 59 years old) were analyzed. Multivariable logistic regression models accounting for sampling weights and adjusting for cardiovascular risk factors were used to assess associations between a history of monthly cannabis use before MI and a subsequent MI. A quarter of respondents (n = 2,220) reported a history of monthly use >1 year before an MI. A history of MI was reported by 2.1% of all respondents and 3.2.% of those who reported a history of monthly use. In fully adjusted multivariable models, and compared with never use, a history of monthly cannabis use preceding an MI was not associated with an MI (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35 to 1.71). However, when stratified by recent use, the odds of MI were threefold greater (OR 2.98, 95% CI 1.08 to 8.60) when no use was reported within the past month than when use was reported within the past month. Duration of monthly use was also not significantly associated with MI, including monthly use >10 years (OR 0.78, 95% CI 0.30 to 2.01). In conclusion, in a representative sample of middle-aged US adults, a history of monthly cannabis use >1 year before an MI was not associated with a subsequent physician-diagnosed MI, except for threefold greater odds when cannabis was not used within the past month.

BACKGROUND: Data comprehensively examining trends in central nervous system (CNS)-active polypharmacy are limited. The objective of this cross-sectional study was to characterize the composition of and trends in CNS-active medication use in US adults. METHODS: We included all participants ≥ 18 years old in the National Health and Nutrition Examination Study (NHANES), 2009-2020. The primary outcome was the percent of adults with CNS-active polypharmacy. This was defined as ≥ 3 medications among antidepressants [tricyclic, selective and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs), opioids, antiepileptics, antipsychotics, benzodiazepines, and nonbenzodiazepine receptor agonists (Z-drugs)]. Secondary outcomes included prevalence of any CNS-active medication and specific medications and classes over time, and their indications. Percentages were weighted according to NHANESs nationally representative sampling frame. log binomial regressions evaluated the relative risk (RR) for each outcome, comparing the last (2017-2020) versus the first (2010-2011) survey cycle. RESULTS: We included 34,189 adults (18.8% at least 65 years old) from five serial cross-sections (survey cycles). The prevalence of CNS-active polypharmacy was 2.1% in 2009-2010 and 2.6% in 2017-2020 [RR 1.18, 95% confidence interval (CI) 0.94-1.47]. The prevalence of CNS-active polypharmacy did not significantly change within any specific age group (e.g., age at least 65 years: RR 1.29, CI 0.74-2.24). The prevalence of any CNS-active medication was 21.0% in 2009 and 24.6% in 2017-2020 (RR] 1.12, 95% CI 1.02-1.25). A substantial increase occurred for antiepileptics (5.1-8.3%), specifically among participants aged 65 years and older (8.3-13.7%). This was largely driven by increasing gabapentin prevalence (1.4-3.6% overall; 3.3-7.9% age 65 years and older). Anticholinergic, SSRIs/SNRIs, antiepileptics, and benzodiazepines were elevated in most cycles for participants at least 65 years old compared with participants less than 65 years, and opioid use was increased in several cycles for older participants as well. Alprazolam was the most common benzodiazepine and third most common medication for anxiety/depression. Gabapentin was the most common CNS-active medication (3.6% of all participants in 2017-2020), followed by sertraline, citalopram, and acetaminophen-hydrocodone (each ~2%). The most common categories were antidepressants (13.7% in 2017-2020), followed by opioids (5.1% in 2017-2020). CONCLUSIONS: CNS-active medications are increasingly common, particularly gabapentin, and use of any CNS-active medication increased by 12%. Numerous CNS-active classes also increased in older adults throughout the years. Increasing suboptimal medication use highlight the need for further investigation into causes for potentially inappropriate prescribing, particularly for older adults.

Abstract Background Amino acids are crucial for nutrition and metabolism, regulating metabolic pathways and activities vital to organismal health and stability. Glycine and histidine act as potent antioxidants and anti-inflammatory agents; however, limited knowledge exists regarding the associations between these amino acids and hyperlipidemia and hypertension. The purpose of this study is to investigate the relationship between dietary glycine and histidine, and hyperlipidemia and hypertension. Methods This population-based cross-sectional study evaluated the influence of dietary glycine and histidine, as well as their combined effect, on hyperlipidemia and hypertension in Chinese adults participating in the Nutrition Health Atlas Project (NHAP). General characteristics were acquired using a verified Internet-based Dietary Questionnaire for the Chinese. Binary logistic regression, along with gender, age groups, and median energy intake subgroup analyses, was employed to investigate the associations between dietary glycine and histidine and hyperlipidemia and hypertension. A sensitivity analysis was conducted to assess the impact of excluding individuals who smoke and consume alcohol on the results. Results Based on the study’s findings, 418 out of 1091 cases had hyperlipidemia, whereas 673 had hypertension. A significant inverse relationship was found between dietary glycine, histidine, and glycine + histidine and hyperlipidemia and hypertension. Compared with the 1st and 2nd tertiles, the multivariable-adjusted odd ratios (ORs) (95% confidence intervals) (CIs) of the 3rd tertile of dietary glycine for hyperlipidemia and hypertension were 0.64 (0.49–0.84) (p

In recent years, a replication crisis in psychiatry has led to a growing focus on the impact of researchers analytic decisions on the results from studies. Multiverse analyses involve examining results across a wide array of possible analytic decisions (e.g., log-transforming variables, number of covariates, or treatment of outliers) and identifying if study results are robust to researchers analytic decisions. Studies have begun to use multiverse analysis for well-studied relationships that have some heterogeneity in results/conclusions across studies.We examine the well-studied relationship between peripheral inflammatory markers (PIMs; e.g., white blood cell count (WBC) and C-reactive protein (CRP)) and depression severity in the large NHANES dataset (n = 25,962). Specification curve analyses tested the impact of 9 common analytic decisions (comprising of 58,000+ possible combinations) on the association of PIMs and depression severity. Relationships of PIMs and total depression severity are robust to analytic decisions (based on tests of inference jointly examining effect sizes and p-values). However, moderate/large differences are noted in effect sizes based on analytic decisions and the majority of analyses do not result in significant findings, with the percentage of analyses with statistically significant results being 46.1% for WBC and 43.8% for CRP. For associations of PIMs with specific symptoms of depression, some associations (e.g., sleep, appetite) in males (but not females) were robust to analytic decisions. We discuss how multiverse analyses can be used to guide research and also the need for authors, reviewers, and editors to incorporate multiverse analyses to enhance replicability of research findings.

BackgroundSome hormonally active cancers have low survival rates, but a large proportion of their incidence remains unexplained. Endocrine disrupting chemicals may affect hormone pathways in the pathology of these cancers.ObjectiveTo evaluate cross-sectional associations between per- and polyfluoroalkyl substances (PFAS), phenols, and parabens and self-reported previous cancer diagnoses in the National Health and Nutrition Examination Survey (NHANES).MethodsWe extracted concentrations of 7 PFAS and 12 phenols/parabens and self-reported diagnoses of melanoma and cancers of the thyroid, breast, ovary, uterus, and prostate in men and women (≥20 years). Associations between previous cancer diagnoses and an interquartile range increase in exposure biomarkers were evaluated using logistic regression models adjusted for key covariates. We conceptualized race as social construct proxy of structural social factors and examined associations in non-Hispanic Black, Mexican American, and other Hispanic participants separately compared to White participants.ResultsPrevious melanoma in women was associated with higher PFDE (OR:2.07, 95% CI: 1.25, 3.43), PFNA (OR:1.72, 95% CI: 1.09, 2.73), PFUA (OR:1.76, 95% CI: 1.07, 2.89), BP3 (OR: 1.81, 95% CI: 1.10, 2.96), DCP25 (OR: 2.41, 95% CI: 1.22, 4.76), and DCP24 (OR: 1.85, 95% CI: 1.05, 3.26). Previous ovarian cancer was associated with higher DCP25 (OR: 2.80, 95% CI: 1.08, 7.27), BPA (OR: 1.93, 95% CI: 1.11, 3.35) and BP3 (OR: 1.76, 95% CI: 1.00, 3.09). Previous uterine cancer was associated with increased PFNA (OR: 1.55, 95% CI: 1.03, 2.34), while higher ethyl paraben was inversely associated (OR: 0.31, 95% CI: 0.12, 0.85). Various PFAS were associated with previous ovarian and uterine cancers in White women, while MPAH or BPF was associated with previous breast cancer among non-White women.Impact statementBiomarkers across all exposure categories (phenols, parabens, and per- and poly- fluoroalkyl substances) were cross-sectionally associated with increased odds of previous melanoma diagnoses in women, and increased odds of previous ovarian cancer was associated with several phenols and parabens. Some associations differed by racial group, which is particularly impactful given the established racial disparities in distributions of exposure to these chemicals. This is the first epidemiological study to investigate exposure to phenols in relation to previous cancer diagnoses, and the first NHANES study to explore racial/ethnic disparities in associations between environmental phenol, paraben, and PFAS exposures and historical cancer diagnosis.

BACKGROUND: In medicine, clinicians treat individuals under an implicit assumption that high-risk patients would benefit most from the treatment (high-risk approach). However, treating individuals with the highest estimated benefit using a novel machine-learning method (high-benefit approach) may improve population health outcomes. METHODS: This study included 10 672 participants who were randomized to systolic blood pressure (SBP) target of either 0) versus the high-risk approach (treating individuals with SBP ≥130 mmHg). Using transportability formula, we also estimated the effect of these approaches among 14 575 US adults from National Health and Nutrition Examination Surveys (NHANES) 1999-2018. RESULTS: We found that 78.9% of individuals with SBP ≥130 mmHg benefited from the intensive SBP control. The high-benefit approach outperformed the high-risk approach [average treatment effect (95% CI), +9.36 (8.33-10.44) vs +1.65 (0.36-2.84) percentage point; difference between these two approaches, +7.71 (6.79-8.67) percentage points, P-value

(1) Background: To analyze the prevalence and factors associated with diabetes mellitus in adults and the elderly in Rio Branco, Acre, Western Brazilian Amazon. (2) Methods: The R software version 4.0.5 was used for estimating the prevalence of diabetes mellitus, odds ratios, and 95% confidence intervals. Multiple analysis was conducted through hierarchical variable selection. (3) Results: 1.095 individuals aged 18 years and older participated in this study, with 6.4% of the respondents showing prevalence of diabetes mellitus. The prevalence of diabetes mellitus was positively associated with a prior medical diagnosis of obesity (OR: 3.2; 95% CI: 1.67–6.12), dyslipidemia (OR: 4.17; 95% CI: 2.08–8.36), and increasing age (OR: 1.07; 95% CI: 1.05–1.09). Conversely, an inverse association was observed with higher education (12 or more years of study; OR: 0.20; 95% CI: 0.07–0.61). (4) Conclusions: The prevalence of diabetes mellitus in the municipality of Rio Branco, Acre, Brazil, has significantly increased with advancing age. Education, obesity, and dyslipidemia were also identified as factors associated with diabetes mellitus in this population. Awareness campaigns regarding dietary patterns and lifestyle choices may serve as preventive and control measures.

Backgrounds: Metabolic dysfunction-associated steatotic liver disease (MASLD) has gained attention owing to its severe complications. This study aimed to explore the interaction between Mediterranean-diet (MD) adherence, genetic factors, and MASLD risk in a Korean population. Methods: In total, 33,133 individuals aged 40 years and older from the Korean Genome and Epidemiology Study (KoGES) were analyzed. Participants were assessed for MASLD based on criteria and MD adherence measured by the Korean version of the Mediterranean-Diet Adherence Screener (K-MEDAS). Individuals were categorized into two groups based on their MD adherence: high adherence (K-MEDAS > 6) and low adherence (K-MEDAS < 5). Single nucleotide polymorphism (SNP) genotypes were obtained using the Korea Biobank array. Logistic regression was used to examine the single-marker variants for genetic associations with MASLD prevalence. Results: Individuals were categorized into MASLD (10,018 [30.2%]) and non-MASLD (23,115 [69.8%]) groups. A significant interaction was observed between the rs780094 glucokinase regulatory protein (GCKR) gene and K-MEDAS on MASLD (p < 10 - 2 ). Of individuals with K-MEDAS > 6, those carrying the minor allele (C) of the GCKR gene rs780094 exhibited a lower risk of MASLD compared to those without the allele (odds ratio [OR] = 0.88 [0.85–0.91], p-value = 5.54e−13). Conclusion: The study identified a significant interaction involving the rs780094 variant near the GCKR gene, with carriers of the minor allele exhibiting a lower MASLD risk among those adhering well to the MD. Dietary habits influence the MASLD risk associated with the rs780094 allele, emphasizing the need for personalized nutrition recommendations. [ABSTRACT FROM AUTHOR]

The relationship between inflammatory dietary patterns and the risk of depression/anxiety has not been clearly established due to differences in study populations, geographic regions, sex, and methods of calculating the inflammatory index. We drew upon a prospective cohort in the UK Biobank and calculated the energy-adjusted dietary inflammatory index (E -DII). The follow-up time was defined from the date of completing the last dietary survey questionnaire to the date of diagnosis of depression, anxiety, phobic anxiety, other types of anxiety, death, loss to follow-up, or the respective censoring dates for England (September 30, 2021), Scotland (July 31, 2021), and Wales (February 28, 2018). The final follow-up times end on September 30, 2021, July 31, 2021, and February 28, 2018, for England, Scotland, and Wales, respectively. During the follow-up process, if a participant develops the condition, dies, or is lost to follow-up, the follow-up is terminated. We used Cox regression to evaluate the connection between E -DII and depression/anxiety. We employed restricted cubic spline curves for nonlinear relationships. We also conducted mediation analyses to explore whether biological age mediated the relationship between E -DII and depression. Additionally, we investigated whether genetic susceptibility modified the relationship between E-DII and depression through interaction modeling. In the final analysis, we included a total of 151,295, 159,695, 165,649, and 160,097 participants for the analysis of depression, all types of anxiety, specific phobia anxiety, and other types of anxiety, respectively. For every one-unit increase in E -DII, the risk of experiencing depression and anxiety increased by 5 % and 4 %, respectively. We identified a "J"-shaped nonlinear relationship (P for nonlinear = 0.003) for both depression and anxiety. A significant association with an elevated risk of depression was observed when E -DII exceeded 0.440, and an increased risk of anxiety was noted when E-DII was more than −0.196. Mediation analysis demonstrated that PhenoAge age acceleration (AA) (For depression, proportion of mediation = 9.6 %; For anxiety, proportion of mediation = 10.1 %) and Klemera-Doubal method Biological Age (KDM AA) (For depression, proportion of mediation = 2.9 %; For anxiety, proportion of mediation = 5.1 %) acted as mediators between E -DII and the development of depression and anxiety (P < 0.05). Diets with pro-inflammatory characteristics are associated with a heightened risk of depression and anxiety. Furthermore, the association of pro-inflammatory diets and depression is mediated by biological age. • Survival analysis with dose-response examined diet's link to depression/anxiety. • Investigating how biological aging mediates inflammation-related diet's impact on depression and anxiety. • Further studies were conducted based on the genetic susceptibility of the participants. • An analysis based on data from a large cohort. [ABSTRACT FROM AUTHOR]

Background: External apical root resorption (EARR) is a common undesirable outcome of orthodontic treatment, this study aimed to identify genetic polymorphisms associated with the susceptibility to extreme orthodontic-induced EARR in a Korean population using extreme phenotype analysis sampling. Methods: Genomic DNA was isolated from the saliva of 77 patients who underwent orthodontic treatment involving two maxillary premolar extractions. The patients were divided into two groups based on EARR values measured on periapical radiographs: The significant resorption group (SG, EARR ≥ 4 mm) and the normal group (NG, EARR < 2 mm). In the NG group, patients with EARR < 1 mm were named the non-resorption group (NonG). Targeted next-generation sequencing was performed using the screened single nucleotide polymorphisms (SNPs), and firth logistic regression analysis was used to determine genetic associations with EARR. Haplotype-based association analysis was performed for specific SNPs. Results: SNPs related to genes TNFSF11, TNFRSF11B, WNT3A, SFRP2, LRP6, P2RX7, and LRP1 were found to be significantly associated with severe EARR (p < 0.05, pre-Bonferroni correction p-values). Additionally, the haplotype CCA of rs17525809, rs208294, and rs1718119 P2RX7 had a higher frequency in the SG group. Conclusion: Extreme phenotype analysis has identified eleven SNPs related to genes TNFSF11, TNFRSF11B, WNT3A, SFRP2, LRP6, P2RX7, and LRP1 that are associated with severe root resorption in the Korean population. These findings will contribute to the development of predictive diagnostic tools for identifying severe root resorption that may occur during orthodontic treatment. [ABSTRACT FROM AUTHOR]

The Expanded National Nutrition Survey (ENNS), formerly the National Nutrition Survey, is a regularly conducted survey that records the Philippines' overall nutritional status. This is especially important not only for government intervention and policy-making but also for private sector entities that plan for their nutrition and development programs. First deployed during the conduct of the 2013 ENNS, the electronic data collection system (EDCS) is a tool that implemented computer-assisted personal interviewing (CAPI) functionalities. This paper records the improvements made to this system and its division into separate subsystems, various CAPI subsystems with specialized functionalities, and how they interact with each other. Descriptive analysis was used for the users' feedback and recommendations -- specifically, for usability and navigation, system performance and portability, technicality and security, and visual design. The system is able to support interviews during the ENNS and receive positive feedback -- garnering visual design the highest, whereas technicality and security the lowest acceptability rating -- thereby proving this division useful. Overall, the system is capable of supporting the ENNS and will continue its improvement through the continual user feedback received. [ABSTRACT FROM AUTHOR]

Background: The association between dietary protein intake and constipation remains inconclusive. The aim of this study was to investigate whether dietary protein intake is associated with constipation. Methods: This cross‐sectional study included 13,941 adults from the 2005 to 2010 National Health and Nutrition Examination Survey. A weighted logistic regression analysis was used to control for confounding factors. In addition, weighted interaction and stratified analyses were conducted to ascertain the potential modifying factors. Results: The prevalence of constipation was 7.5% when constipation was defined by stool consistency and 3.5% when constipation was defined by stool frequency. After adjusting for covariates, an increase in dietary protein intake of 10 g was not associated with constipation, as defined by stool frequency (OR = 0.94, 95% CI = 0.54, 1.62) or stool consistency (OR = 1.02, 95% CI = 0.75, 1.39). Subgroup analyses revealed that dietary protein intake was associated with an increase in constipation defined by stool consistency risk in participants who consumed a low amount of carbohydrates (OR = 1.08, 95% CI = 1.02–1.14 for every 10‐g increase in protein intake), but a decrease in risk in participants in the moderate‐carbohydrate group (OR = 0.94, 95% CI = 0.89–0.99 for every 10‐g increase in protein intake), suggesting a significant interaction (p = 0.001). Conclusion & Inferences: Dietary protein intake is not associated with stool consistency or frequency‐defined constipation. However, the association between dietary protein intake and constipation defined by stool consistency in participants with a low carbohydrate intake differed from that in participants with a moderate carbohydrate intake. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the link between dietary vitamin C intake and hyperuricemia/gout, utilizing Mendelian randomization to assess causality. Methods: We analyzed cross‐sectional data from the National Health and Nutrition Examination Survey (2007–2018) to investigate the association. Mendelian randomization studies, using genetic data from genome‐wide association surveys, were conducted to infer causality between vitamin C intake and hyperuricemia/gout. The weighted logistic regression analysis and the instrumental variable based on the inverse‐variance weighting served as the primary analytical tool, with sensitivity analyses to ensure robustness. Results: After adjusting for covariates, a stable association was observed between vitamin C intake and hyperuricemia/gout risk. Those consuming >111.75 mg of vitamin C generally had a lower risk. Vitamin C intake recommendations of 75–525 mg and 75–225 mg appeared effective for hyperuricemia and gout, respectively. Mendelian randomization analysis revealed a negative association between vitamin C intake and hyperuricemia (OR = 0.985, 95% CI = 0.973–0.997, p =.015) and gout (OR = 0.857, 95% CI = 0.797–0.921, p <.001). Reverse Mendelian randomization indicated no reverse causality. Conclusion: We hypothesize that a dietary vitamin C intake of 75–525 mg or 75–225 mg may reduce the risk of hyperuricemia and gout, respectively. Further research with larger samples is required to confirm this. [ABSTRACT FROM AUTHOR]

Background: Polycyclic aromatic hydrocarbons (PAHs) can invade and cause harm to the human body through various pathways, but there is currently little research on the relationship between mixed‐PAHs exposure and periodontitis. The purpose of this study was to examine the effects of mixed‐urinary PAHs exposure on periodontitis in adults in the United States. Methods: The cross‐sectional study included 2749 subjects selected from the National Health and Nutrition Examination Survey (NHANES) 2009–2014 cycles. A professional examination of the periodontal status was conducted to distinguish between periodontitis and non‐periodontitis based on the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition. Laboratory testing of urine samples was performed to obtain the levels of urinary PAHs. Pearson correlation coefficients were utilized to determine the degree of correlation between urinary PAHs, while weighted binary logistic regression and Bayesian kernel machine regression (BKMR) were employed to evaluate the relationship between urinary PAHs and periodontitis. Results: In a single‐exposure model, 3‐hydroxyfluorene (OH‐3F), 2‐hydroxyfluorene (OH‐2F), 1‐hydroxyphenanthrene (OH‐1Ph), and 2‐hydroxyphenanthrene and 3‐hydroxyphenanthrene (OH‐2,3Ph) were positively associated with periodontitis risk. In the mixed‐exposure model, BKMR analysis demonstrated that mixed exposure to urinary PAHs was positively associated with periodontitis, with OH‐2F being the most critical factor for the overall mixed effects (posterior inclusion probability [PIP] = 0.98). Univariate exposure–response function and univariate effects analysis revealed a positive correlation between urinary OH‐2F levels and periodontitis. Conclusions: The study reveals a significant positive correlation between exposure to mixed PAHs and periodontitis, with a particular emphasis on the pivotal role of OH‐2F. Mitigating PAHs in the environment may serve as a preventive measure against periodontitis and alleviate its global public health burden. [ABSTRACT FROM AUTHOR]

Background: The Guangzhou Nutrition and Health Study (GNHS) aims to assess the determinants of metabolic disease in nutritional aspects, as well as other environmental and genetic factors, and explore possible biomarkers and mechanisms with multi-omics integration. Methods: The population-based sample of adults in Guangzhou, China (baseline: 40-83 years old; n = 5,118) was followed up about every 3 years. All are tracked via on-site follow-up and health information systems. We assessed detailed information on lifestyle factors, physical activities, dietary assessments, psychological health, cognitive function, body measurements, and muscle function. Instrument tests included dual-energy X-ray absorptiometry scanning, carotid artery and liver ultrasonography evaluations, vascular endothelial function evaluation, upper-abdomen and brain magnetic resonance imaging, and 14-day real-time continuous glucose monitoring tests. We also measured multi-omics, including host genome-wide genotyping, serum metabolome and proteome, gut microbiome (16S rRNA sequencing, metagenome, and internal transcribed spacer 2 sequencing), and fecal metabolome and proteome. Results: The baseline surveys were conducted from 2008 to 2015. Now, we have completed 3 waves. The 3rd and 4th follow-ups have started but have yet to end. A total of 5,118 participants aged 40-83 took part in the study. The median age at baseline was approximately 59.0 years and the proportion of female participants was about 69.4%. Among all the participants, 3,628 (71%) completed at least one on-site follow-up, with a median duration of 9.48 years. Conclusion: The cohort will provide data that will be influential in establishing the role of nutrition in metabolic diseases with multi-omics. [ABSTRACT FROM AUTHOR]

Background: Several genetic studies have been undertaken to elucidate the intricate interplay between genetics and drug responses in bipolar disorder (BD). However, there has been notably limited research on biomarkers specifically linked to valproate, with only a few studies investigating integrated proteomic and genomic factors in response to valproate treatment. Therefore, this study aimed to identify biological markers for the therapeutic response to valproate treatment in BD. Patients with BD in remission were assessed only at baseline, whereas those experiencing acute mood episodes were evaluated at three points (baseline, 8 ± 2 weeks, and 6 ± 1 months). The response to valproate treatment was measured using the Alda scale, with individuals scoring an Alda A score ≥ 5 categorized into the acute-valproate responder (acute-VPAR) group. We analyzed 158 peptides (92 proteins) from peripheral blood samples using multiple reaction monitoring mass spectrometry, and proteomic result-guided candidate gene association analyses, with 1,627 single nucleotide variants (SNVs), were performed using the Korean chip. Results: The markers of 37 peptides (27 protein) showed temporal upregulation, indicating possible association with response to valproate treatment. A total of 58 SNVs in 22 genes and 37 SNVs in 16 genes showed nominally significant associations with the Alda A continuous score and the acute-VPAR group, respectively. No SNVs reached the genome-wide significance threshold; however, three SNVs (rs115788299, rs11563197, and rs117669164) in the secreted phosphoprotein 2 gene reached a gene-based false discovery rate-corrected significance threshold with response to valproate treatment. Significant markers were associated with the pathophysiological processes of bipolar disorders, including the immune response, acute phase reaction, and coagulation cascade. These results suggest that valproate effectively suppresses mechanisms associated with disease progression. Conclusions: The markers identified in this study could be valuable indicators of the underlying mechanisms associated with response to valproate treatment. [ABSTRACT FROM AUTHOR]

Protein is a vital dietary component for combating negative health outcomes associated with malnutrition in older adults, including sarcopenia, functional decline and reduced quality of life. Yet, recommended daily protein intake is consistently unmet, as evidenced in the literature and reaffirmed in this review. Poor appetite is recognized as a major determinant of protein-energy undernutrition and thus fortification of regular food or drinks provides a flexible and relevant approach for older adults with reduced appetite. To increase the likelihood of fortified products being successfully incorporated into the diets of older adults, they must be adaptable to older adults eating patterns, cater for their preferences and take the specific age-related problems that complicate food intake into account. This paper aims to highlight older adults' current sources of protein, shopping habits, typical eating patterns and commonly consumed foods, and hence consider appropriate carriers for protein enrichment. Data were reanalyzed from a combination of freely available UK datasets, including the National Dietary and Nutrition Survey and the Food and You Survey, alongside data purchased from market research consultancy, Kantar. These insights draw attention to the potential suitability of foods for fortification purposes, with the ultimate objective to promote eating pleasure and prevent malnutrition. [ABSTRACT FROM AUTHOR]