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Abstract Background/Objectives To date, evidence regarding the protective roles of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet in patients with type 2 diabetes mellitus (T2DM) is scarce. This study aims to estimate the impact of adhering to the MIND diet on the mortality in patients with and without T2DM. Subjects/Methods In this cohort study, 6887 participants (1021 patients with T2DM) from the NHANES dataset were analyzed. The exposure is the MIND diet adherence. The primary outcomes are all-cause and cardiovascular (CV) deaths. Results We documented 1087 all-cause deaths consisting of 377 CV deaths during the follow-up (median time of 10 years). Among participants with T2DM, those with a high MIND score (> 8.0, range of MIND score: 4.5–13) had a significantly lower risk of all-cause death (hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.59, 0.96, P = 0.021) and CV death (HR 0.50, 95% CI: 0.29, 0.87, P = 0.014) compared to those with a low MIND score (≤ 8.0). In participants without T2DM, a high MIND score was associated with a significant decrease in the risk of all-cause death (HR = 0.83, 95% CI: 0.70, 0.99, P

Summary: Background: Social isolation and loneliness pose significant public health challenges globally. The objective of this study is to investigate the association between social isolation, loneliness, and the risk of type 2 diabetes mellitus (T2DM). Methods: 423,503 UK adults from the UK Biobank (UKB) and 13,800 Chinese adults from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. The exposures of interest were social isolation and loneliness. Social isolation was evaluated based on the number of household members, frequency of social activities, contact with others, and marriage status (CHARLS only). Loneliness was evaluated by the subjective feeling of loneliness and the willingness to confide in others (UKB only). The primary endpoint was incident T2DM. The two-sample Mendelian randomization (MR) analysis was based on the genome-wide association studies of UKB (n = 463,010) and the European Bioinformatics Institute (n = 655,666). Findings: The UKB cohort study documented 15,072 T2DM cases during a mean follow-up of 13.5 years, and the CHARLS cohort study recorded 1,249 T2DM cases during a mean follow-up of 5.8 years. Social isolation and loneliness showed significant associations with an elevated risk of T2DM in both UKB (social isolation [most vs least]: HR 1.17, 95% CI 1.11–1.23; loneliness [yes vs no]: HR 1.21, 95% CI 1.13–1.30) and CHARLS cohorts (social isolation [yes vs no]: HR 1.22, 95% CI 1.06–1.40; loneliness [yes vs no]: HR 1.21, 95% CI 1.07–1.36). These associations remained significant after accounting for baseline glucose status and genetic susceptibility to T2DM. Two-sample MR analyses determined that feeling lonely (OR 1.04, 95% CI 1.02–1.06) and engaging in fewer leisure/social activities (OR 1.03, 95% CI 1.02–1.05) were associated with increased T2DM risk, whereas more contact with friends or family (OR 0.99, 95% CI 0.98–0.99) was associated with reduced T2DM risk. Interpretation: Social isolation and loneliness are each associated with an elevated risk of T2DM, with MR analyses suggesting potential causal links. These associations remain significant after considering genetic susceptibility to T2DM. The findings highlight the importance of promoting initiatives to address social isolation and loneliness as part of T2DM prevention strategies. Funding: CAMS Innovation Fund for Medical Sciences (No. 2021-I2M-1-008) and National Natural Science Foundation of China (No. 72103187).

BackgroundThe Mediterranean-Dietary Approaches to Stop Hypertension for neurodegenerative delay (MIND) has been regarded as a novel healthy dietary pattern with huge benefits. However, its value in preventing and treating hypertension has not been investigated. The objective of this study is to investigate the impact of adhering to the MIND diet on the prevalence of hypertension in the entire population and long-term mortality in hypertensive patients.MethodsIn this cross-sectional and longitudinal study, 6,887 participants consisting of 2,984 hypertensive patients in the National Health and Nutritional Examination Surveys were analyzed and divided into 3 groups according to the MIND diet scores (MDS; groups of MDS-low [

Abstract Background Studies on the associations between ambient temperature and asthma hospitalizations are limited, and the results are controversial. We aimed to assess the short-term effects of ambient temperature on the risk of asthma hospitalizations and quantify the hospitalization burdens of asthma attributable to non-optimal temperature in adults in Beijing, China. Methods We collected daily asthma hospitalizations, meteorological factors and air quality data in Beijing from 2012 to 2015. We applied a time-stratified case-crossover design and fitted a distributed lag non-linear model with a conditional quasi-Poisson regression to explore the association between ambient temperature and adult asthma hospitalizations. The effect modifications of these associations by gender and age were assessed by stratified analyses. We also computed the attributable fractions and numbers with 95% empirical confidence intervals (eCI) of asthma hospitalizations due to extreme and moderate temperatures. Results From 2012 to 2015, we identified a total of 18,500 hospitalizations for asthma among adult residents in Beijing, China. Compared with the optimal temperature (22 °C), the cumulative relative risk (CRR) over lag 0–30 days was 2.32 with a 95% confidence interval (CI) of 1.57–3.42 for extreme cold corresponding to the 2.5th percentile (− 6.5 °C) of temperature distribution and 2.04 (95% CI 1.52–2.74) for extreme heat corresponding to the 97.5th percentile (29 °C) of temperature distribution. 29.1% (95% eCI 17.5–38.0%) of adult asthma hospitalizations was attributable to non-optimum temperatures. Moderate cold temperatures yielded most of the burdens, with an attributable fraction of 20.3% (95% eCI 9.1–28.7%). The temperature-related risks of asthma hospitalizations were more prominent in females and younger people (19–64 years old). Conclusions There was a U-shaped association between ambient temperature and the risk of adult asthma hospitalizations in Beijing, China. Females and younger patients were more vulnerable to the effects of non-optimum temperatures. Most of the burden was attributable to moderate cold. Our findings may uncover the potential impact of climate changes on asthma exacerbations.

BackgroundIn the context of global climate changes, increasing extreme weather events have aroused great public concern. Limited evidence has focused on the association between extreme precipitation and hospitalizations for acute myocardial infarction (AMI). Our study aimed to examine the effect of extreme precipitation on AMI hospitalizations.MethodsDaily AMI hospitalizations, weather variables and air pollution data in Beijing from 2013 to 2018 were obtained. We used a time-series analysis with a distributed lag model to evaluate the association of extreme precipitation (≥95th percentile of daily precipitation) with AMI hospitalizations. Subgroup analysis was conducted to identify the vulnerable subpopulations and further assessed the attributable burden.ResultsExtreme precipitation increased the risk of AMI hospitalizations with significant single-day effects from Lag 4 to Lag 11, and the maximum cumulative effects at Lag 0–14 (CRR = 1.177, 95% CI: 1.045, 1.326). Older people (≥65 years) and females were more vulnerable to extreme precipitation. The attributable fraction and numbers of extreme precipitation on AMI hospitalizations were 0.68% (95% CI: 0.20%, 1.12%) and 854 (95% CI: 244, 1,395), respectively.ConclusionExtreme precipitation is correlated with a higher risk of AMI hospitalizations. The elderly (≥65 years) and females are more susceptible to AMI triggered by extreme precipitation.

Background: Since the foundation of appropriate use criteria (AUC) for coronary revascularization, the proportion of inappropriate (later revised as “rarely inappropriate”) percutaneous coronary interventions (PCIs) varied in different populations. However, the pooled inappropriate PCI rate remains unknown. Methods: We searched the PubMed, Cochrane, Embase, and Sinomed databases for studies related to AUC and PCIs. Studies that reported inappropriate/rarely appropriate PCI rates were included. A random effects model was employed in the meta-analysis because of the high statistical heterogeneity. Results: Thirty-seven studies were included in our study, of which eight studies reported the appropriateness of acute PCIs or PCIs in acute coronary syndrome (ACS) patients, 25 studies reported the appropriateness of non-acute/elective PCIs or PCIs in non-ACS/stable ischemic heart disease (SIHD) patients, and 15 studies reported both acute and non-acute PCIs or did not distinguish the urgency of PCI. The pooled inappropriate PCI rate was 4.3% (95% CI: 2.6–6.4%) in acute scenarios, 8.9% (95% CI: 6.7–11.0%) in non-acute scenarios, and 6.1% (95% CI: 4.9–7.3%) overall. The inappropriate/rarely appropriate PCI rate was significantly higher in non-acute than acute scenarios. No difference in the inappropriate PCI rate was detected based on the study location, the country’s level of development, or the presence of chronic total occlusion (CTO). Conclusions: The worldwide inappropriate PCI rate is generally identical but comparatively high, especially under non-acute scenarios.

Background: Previous studies suggested that exposure to air pollution could increase risk of asthma attacks in children. The aim of this study is to investigate the short-term effects of exposure to ambient air pollution on asthma hospital admissions in children in Beijing, a city with serious air pollution and high-quality medical care at the same time.Methods: We collected hospital admission data of asthma patients aged ≤ 18 years old from 56 hospitals from 2013 to 2016 in Beijing, China. Time-stratified case-crossover design and conditional Poisson regression were applied to explore the association between risk of asthma admission in children and the daily concentration of six air pollutants [particulate matter ≤ 2.5 μm (PM2.5), particulate matter ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)], adjusting for meteorological factors and other pollutants. Additionally, stratified analyses were performed by age, gender, and season.Results: In the single-pollutant models, higher levels of PM2.5, SO2, and NO2 were significantly associated with increased risk of hospital admission for asthma in children. The strongest effect was observed in NO2 at lag06 (RR = 1.25, 95%CI: 1.06-1.48), followed by SO2 at lag05 (RR = 1.17, 95%CI: 1.05–1.31). The robustness of effects of SO2 and NO2 were shown in two-pollutant models. Stratified analyses further indicated that pre-school children (aged ≤ 6 years) were more susceptible to SO2. The effects of SO2 were stronger in the cold season, while the effects of NO2 were stronger in the warm season. No significant sex-specific differences were observed.Conclusions: These results suggested that high levels of air pollution had an adverse effect on childhood asthma, even in a region with high-quality healthcare. Therefore, it will be significant to decrease hospital admissions for asthma in children by controlling air pollution emission and avoiding exposure to air pollution.

Aims: We aimed to assess the association between serum 25-hydroxyvitamin D (25(OH)D) levels with all-cause and cardiovascular mortality in patients with nonalcoholic fatty liver disease (NAFLD). Methods: We performed a retrospective cohort study based on the US National Health and Nutrition Examination Survey 2001–2016 on adults aged ≥20 years. NAFLD was determined as a US Fatty Liver Index score ≥ 30 in the absence of other liver conditions. Weighted Cox proportional hazards regression models were applied to explore the relationship between serum 25(OH)D levels and mortality. Results: 898 all-cause deaths and 305 cardiovascular deaths were recorded over a median follow-up of 8.7 years. Compared with those in the severe deficiency group (below 25.0 nmol/L), the fully adjusted HRs and 95% CIs of NAFLD patients with sufficient serum 25(OH)D concentrations (≥75.0 nmol/L) were 0.36 (0.22, 0.60) for all-cause mortality and 0.14 (0.07, 0.29) for cardiovascular mortality. Each one-unit increase in the natural log-transformed serum 25(OH)D concentration was related to a 41% lower risk for all-cause deaths (HR = 0.59, 95% CI: 0.46, 0.77) and a 65% lower risk for cardiovascular deaths (HR = 0.35, 95% CI: 0.22, 0.58). Conclusions: Among NAFLD patients, increased serum 25(OH)D levels were independently associated with reduced risk for all-cause and cardiovascular deaths.

Objectives Our work aimed at exploring the relationship between cold spells and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalisations in Beijing, China, and assessing the moderating effects of the intensities and the durations of cold spells, as well as identifying the vulnerable.Design A time-series study.Setting We obtained time-series data of AECOPD hospitalisations, meteorological variables and air quality index in Beijing, China during 2012–2016.Participants All AECOPD hospitalisations among permanent residents in Beijing, China during the cold seasons (November–March) of 2012–2016 were included (n=84 571).Primary and secondary outcome measures A quasi-Poisson regression with a distributed lag model was fitted to investigate the short-term effects of cold spells on AECOPD hospitalisations by comparing the counts of AECOPD admissions during cold spell days with those during non-cold spell days.Results Cold spells under different definitions were associated with increased risk of AECOPD hospitalisations, with the maximum cumulative relative risk (CRR) over 3 weeks (lag0–21). The cumulative effects at lag0–21 increased with the intensities and the durations of cold spells. Under the optimal definition, the most significant single-day relative risk (RR) was found on the days of cold spells (lag0) with an RR of 1.042 (95% CI 1.013 to 1.072), and the CRR at lag0–21 was 1.394 (95% CI 1.193 to 1.630). The elderly (aged ≥65) were more vulnerable to the effects of cold spells on AECOPD hospitalisations.Conclusion Cold spells are associated with increased AECOPD hospitalisations in Beijing, with the cumulative effects increased with intensities and durations. The elderly are at particular risk of AECOPD hospitalisations triggered by cold spells.