Search Results (611)

Background: Alcohol-associated liver disease (AALD) represents significant health burdens worldwide. This study aims to provide a comprehensive overview of the AALD outcomes that were incompletely understood. Methods: The current study utilizes data from the National Health and Nutrition and Examination Survey (NHANES) from 2011–2020, using a stratified, multistage probability cluster design. AALD in the NHANES was defined using clinical laboratory data and self-reported alcohol use, among which fibrosis-4 score of >2.67. Analysis is conducted using weighted, logistic, and Cox linear regression. Results: The initial sample included 23,206 participants aged 20 and older, with recorded cardiovascular status and AST/ALT levels. Participants reporting AALD had a higher percentage of college degrees (p < 0.001) and were more likely to be daily smokers. Asians exhibited the highest rates of AALD compared to other demographics (p < 0.001). The prevalence in private insurance is significantly greater than Medicaid, but the usage trends have been increasing in Medicaid. The trends of advanced fibrosis have been increasing in blacks and Asians, while they have been decreasing among whites and Mexicans. Those with AALD also had higher mean systolic and diastolic blood pressure, as well as elevated fasting glucose levels (p < 0.001). The mortality rate among AALD participants with heart diseases was 25%, compared to 3% among those without (p < 0.001). After adjusting for potential confounding variables, no statistically significant associations were found between AALD status and HF or CAD. However, a clinically significant increase in the odds of stroke was observed within the AALD group (p < 0.001). Conclusions: Our findings indicate Asians have the highest rates of AALD. The trends of advanced fibrosis have been increasing in blacks and Asians. There is an increased prevalence of AALD with heart diseases and a significant increase in mortality with stroke. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease. It has known multifactorial pathophysiology, but the impact of social determinants of health (SDOH) on the rising prevalence of MASLD is poorly understood. We conducted a retrospective cross-sectional study to examine the influence of SDOH on MASLD using nationwide data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) study. Methods: We identified participants with MASLD based on liver ultrasound-based controlled attenuation parameter measurements consistent with diagnostic guidelines. We then used logistic regression models to examine associations between SDOH variables and MASLD, with a pre-specified focus on education and income, sequentially adjusting for sociodemographic factors, medical comorbidities, and other SDOH. Results: Our study found that higher education (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62–0.97, p = 0.024) but not higher income (OR 1.12, 95% CI 0.91–1.37, p = 0.3) was associated with lower odds of MASLD in multivariable adjusted models. We also identified a significant interaction between education level and food security, as well as interactions between food security and other significant SDOH. In the stratified analyses, higher education was significantly associated with lower odds of MASLD among participants with food security (OR 0.71, 95% CI 0.55–0.91, p = 0.007) but not among those with food insecurity (OR 1.26, 95% CI 0.76–2.11, p = 0.4). Conclusions: Our findings identify the potential impact of SDOH on odds of MASLD and suggest increased importance of food security relative to other SDOH. Full article

Background: Environmental exposures, such as per- and polyfluoroalkyl substances (PFAS), in conjunction with social and behavioral factors, can significantly impact liver health. This research investigates the combined effects of PFAS (perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), alcohol consumption, smoking, income, and education on liver function among the U.S. population, utilizing data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). Methods: PFAS concentrations in blood samples were analyzed using online solid-phase extraction combined with liquid chromatography–tandem mass spectrometry (LC-MS/MS), a highly sensitive and specific method for detecting levels of PFAS. Liver function was evaluated using biomarkers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin, and the fatty liver index (FLI). Descriptive statistics and multivariable linear regression analyses were employed to assess the associations between exposures and liver outcomes. Bayesian Kernel Machine Regression (BKMR) was utilized to explore the nonlinear and interactive effects of these exposures. To determine the relative influence of each factor on liver health, Posterior Inclusion Probabilities (PIPs) were calculated. Results: Linear regression analyses indicated that income and education were inversely associated with several liver injury biomarkers, while alcohol use and smoking demonstrated stronger and more consistent associations. Bayesian Kernel Machine Regression (BKMR) further highlighted alcohol and smoking as the most influential predictors, particularly for GGT and total bilirubin, with posterior inclusion probabilities (PIPs) close to 1.0. In contrast, PFAS showed weaker associations. Regression coefficients were small and largely non-significant, and PIPs were comparatively lower across most liver outcomes. Notably, education had a higher PIP for ALT and GGT than PFAS, suggesting a more protective role in liver health. People with higher education levels tend to live healthier lifestyles, have better access to healthcare, and are generally more aware of health risks. These factors can all help reduce the risk of liver problems. Overall mixture effects demonstrated nonlinear trends, including U-shaped relationships for ALT and GGT, and inverse associations for AST, FLI, and ALP. Conclusion: These findings underscore the importance of considering both environmental and social–behavioral determinants in liver health. While PFAS exposures remain a long-term concern, modifiable lifestyle and structural factors, particularly alcohol, smoking, income, and education, exert more immediate and pronounced effects on hepatic biomarkers in the general population. Full article

Root caries is a form of decay affecting root surfaces of teeth, often exacerbated by periodontal disease, reduced salivary flow, and compromised mucosal health, all factors strongly influenced by nutrition. Despite this connection, few studies have addressed the role of vitamins in oral health. This study examines the association between serum levels of alpha-carotene (α-carotene), a potent antioxidant and proxy for vitamin A, and the experience of root caries. Using data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES), we conducted a cross-sectional analysis and applied a weighted multiple logistic regression model, adjusting for potential confounders including age, sex, education level, race, income-to-poverty ratio, and presence of gum disease. Higher serum α-carotene levels were inversely associated with root caries. Each unit increase in serum α-carotene was associated with a 9% decrease in the odds of having root caries (OR = 0.91; 95% CI: 0.86–0.97; p = 0.004). In this nationally representative sample of U.S. adults, lower serum α-carotene levels were associated with a higher prevalence of root caries. These findings highlight the potential role of nutritional assessment and integration in oral health. Longitudinal and mechanistic studies are needed to confirm and further explore α-carotene’s effects on oral health. Full article

Background/Objectives: Despite the health benefits of fiber intake, most Americans do not meet the dietary recommendations for this nutrient. With barley, buckwheat and quinoa containing several nutrients, including fiber, the integration of these foods into the American diet could improve diet quality and health. The purpose of this study is to examine the consumption patterns of barley, buckwheat and quinoa and its association with diet and metabolic health markers. Methods: We used National Health and Nutrition Examination Survey (NHANES) 2013–2018 data. Adults who had consumed barley, buckwheat and quinoa, as determined by food codes representing these foods, in at least one of the two 24 h recalls were categorized as consumers. Due to the very low prevalence of buckwheat consumption, the associations of consumption with diet and health markers were examined only for barley and quinoa. Results: The prevalence of barley, buckwheat and quinoa consumption among US adults were 0.36%, 0.04% and 1.07%, respectively. Compared with non-consumers, barley and quinoa consumers had significantly greater diet quality and higher intakes of potassium and fiber. While barley consumption was associated with a lower body mass index, waist circumference and glycohemoglobin, quinoa consumption was associated with a lower body mass index, waist circumference, triglycerides and total cholesterol. Conclusions: In this study, we found an overall low prevalence of the consumption of barley, buckwheat and quinoa among US adults. The consumers of barley and quinoa had better dietary intake compared with non-consumers. Although better metabolic health in consumers may be explained by their overall healthier dietary patterns, understanding the barriers and facilitators to the intake of these foods could inform efforts to improve diet quality and health. Full article

Glyphosate and glyphosate-based herbicides (GBHS) are the most widely used herbicides worldwide, yet their potential endocrine-disrupting effects in humans remain inadequately studied. We analyzed data from 1532 participants aged ≥6 years in the 2017–2018 National Health and Nutrition Examination Survey (NHANES). Serum sex hormones assessed included follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), androstenedione, estrone, estradiol, estrone sulfate, 17α-hydroxyprogesterone, progesterone, and sex hormone-binding globulin (SHBG). We found that higher urinary glyphosate levels were significantly associated with lower concentrations of AMH (β = −0.140, p < 0.05), androstenedione (β = −0.134, p < 0.001), estradiol (β = −0.185, p < 0.05), estrone (β = −0.132, p < 0.05), estrone sulfate (β = −0.196, p < 0.001), 17α-hydroxyprogesterone (β = −0.097, p < 0.05), and progesterone (β = −0.212, p < 0.05). SHBG was positively associated (β = 0.080, p < 0.05). FSH and LH showed no significant associations. These associations were generally linear and showed modification by age. Subgroup analyses revealed stronger negative associations in adult males, while SHBG increased in females. In conclusion, we observed that higher urinary glyphosate levels were significantly associated with alterations in multiple serum sex hormones. Although the cross-sectional design precludes causal inference, these findings underscore the need for longitudinal research to determine temporal relationships and underlying mechanisms. Full article

Background: Diabetes significantly increases the risk of atrial fibrillation (AF), but identifying high-risk individuals remains a clinical challenge. This study aimed to improve AF risk stratification in diabetic patients through a combination of clinical modeling and untargeted metabolomic analysis. Methods: A clinical risk score was developed using data from the National Health and Nutrition Examination Survey (NHANES) and validated in an independent cohort from Tongji Hospital. Its association with long-term outcomes and its ability to predict AF recurrence after catheter ablation were assessed in follow-up studies. Additionally, untargeted plasma metabolomics was performed in a subset of diabetic patients with and without AF to explore underlying mechanism. Results: The risk score showed good predictive performance in both the development and validation cohorts and was significantly associated with clinical prognosis. When combined with left atrial diameter and AF type, it also improved the prediction of AF recurrence after ablation. Metabolomic profiling revealed notable disturbances in energy metabolism, heightened inflammatory activity, and elevated stress responses in AF patients, indicating a distinct metabolic risk profile. Conclusions: This study provided two approaches to identify high-risk AF in diabetic patients, discussed the underlying pathophysiological mechanisms, and compared their characteristics and applications. And integrated strategies could improve AF risk stratification and personalized management in the diabetic. Full article

Background/Objectives: The hemoglobin-to-red blood cell distribution width (RDW) ratio (HRR) reflects the status of inflammation and oxidative stress size. Previously, it has been suggested that HRR is associated with cardiovascular diseases (CVD). However, evidence has been limited for examining the association between HRR and the incidence of specific cardiovascular events (e.g., cardiovascular disease, stroke, congestive heart failure) and all-cause cardiovascular death and non-cardiovascular death, adjusting for known confounders. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) in the year cycle of 1999–2018 were collected. HRR was calculated as the ratio of hemoglobin divided by the RDW. The outcomes were CVD, including stroke, congestive heart failure, atherosclerotic cardiovascular diseases (ASCVD), coronary artery disease as well as all-cause death including cardiovascular death and non-cardiovascular death. Univariate and multivariate analyses were performed to explore the association between HRR and outcomes. Restricted cubic spline curves were delineated. Results: In total, 47,719 participants were eligible for further analysis. In multivariate analysis adjusting for all confounding factors, higher HRR levels were significantly associated with a decreased risk of CVD. Compared to Q1 (<9.86), the odds ratio (OR) and 95% confidence intervals (95% CI) in Q2 (9.86–10.96), Q3 (10.96–11.97), and Q4 (≥11.97) were 0.79 (0.66, 0.94), 0.59 (0.48, 0.73), and 0.53, (0.42, 0.67), respectively, for predicting CVD. Similar results were observed for different subtypes of CVD, including stroke, congestive heart failure, and ASCVD. Notably, for predicting coronary heart disease, only Q3 was significant compared to Q1 (0.70, [0.54, 0.92], p = 0.010). HRR was significant for predicting all-cause death, cardiovascular death, and non-cardiovascular death. Additionally, HRR had the highest discriminative ability for predicting all-cause death compared with that of hemoglobin and RDW. Conclusions: A higher HRR was associated with a lower risk of CVD and death. Moderate levels of HRR were associated with the lowest risk for coronary heart disease. HRR had better discriminative ability than hemoglobin and RDW. Full article

Environmental exposures to heavy metals, polychlorinated biphenyls (PCBs), dioxins, and furans have been associated with adverse cardiovascular outcomes, yet their combined effects remain underexplored. This study examined the joint influence of these contaminants on cardiovascular risk indicators in a representative sample of U.S. adults from the 2003–2004 National Health and Nutrition Examination Survey (NHANES). Biomarkers of exposure included lead, cadmium, mercury, twelve PCB congeners, seven dioxins, and ten furans. Cardiovascular outcomes were assessed using blood pressure, Framingham Risk Score (FRS), and lipid profiles. Associations were analyzed using multivariable linear regression and Bayesian Kernel Machine Regression (BKMR), adjusting for age, sex, ethnicity, body mass index, smoking, alcohol consumption, and income. The results demonstrated that metals, particularly mercury, were strongly associated with increased blood pressure and altered HDL cholesterol. PCBs were predominantly linked to elevated systolic blood pressure and FRS, with PCB156 and PCB126 identified as principal contributors. Furans exhibited the strongest associations with dyslipidemia, including elevated LDL cholesterol, total cholesterol, and triglycerides. Combined exposure analysis revealed a complex pattern, with increasing pollutant burdens associated with rising blood pressure and risk scores but declining lipid levels. These findings underscore the outcome-specific effects of pollutant mixtures and suggest that chronic low-level exposure to multiple environmental contaminants may contribute to cardiovascular dysfunction in the general population. Further longitudinal research is needed to confirm these associations and guide risk reduction strategies. Full article

Per- and polyfluoroalkyl substances (PFASs) are ubiquitous environmental contaminants with potential endocrine-disrupting properties. This study examines the association between exposure to multiple PFASs and pan-cancers associated with sex hormones (PCSH) while accounting for potential non-linear relationships and interactions. We analyzed data from the National Health and Nutrition Examination Survey (NHANES), spanning two-year cycles from 1999 to 2012 and including 14,373 participants. Serum concentrations of six PFAS—perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorodecanoic acid (PFDE), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUA)—were assessed for their relationship with PCSH. The statistical analyses included descriptive statistics, Spearman and Pearson correlation analyses, and both linear and logistic regression models. Additionally, Bayesian kernel machine regression (BKMR) was applied to capture potential nonlinear relationships and interactions. The initial t-tests showed a statistically significant difference in PFOS levels between individuals with and without PCSH (p = 0.0022), with higher mean PFOS levels in the PCSH group. Chi-square tests revealed a significant association between ethnicity and PCSH (p < 0.001). Linear and logistic regression analyses revealed significant associations for PFOS. BKMR analysis identified PFOA as having the highest posterior inclusion probability, indicating its importance in explaining PCSH risk. Univariate exposure-response analysis revealed limited individual PFAS effects. However, bivariate analysis indicated a complex U-shaped interaction pattern among many joint PFAS assessments. The overall exposure effect analysis suggested that the combined impact of all PFASs was more strongly associated with PCSH at exposure levels below the 0.5 quantile compared to higher levels. Single-variable interaction analyses highlighted PFOA and PFOS as the most interactive PFASs when evaluating their interaction with combined exposure to all other PFASs. In summary, while the initial findings suggested a positive association between PFOS and PCSH, the BKMR analysis revealed complex non-linear relationships and interactions among PFAS. These findings highlight the importance of evaluating PFASs as a mixture rather than as individual chemicals and using techniques that can capture non-linear relationships and interactions. Full article

Background and Objectives: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality. The cardiometabolic index (CMI) has been shown to be associated with metabolic disorders and mortality in general populations, but its role in ASCVD-specific mortality risk remains unexplored. Materials and Methods: This cohort study was based on the National Health and Nutrition Examination Survey (NHANES). Weighted Cox proportional hazards models were fitted to estimate the associations between CMI and mortality. Restricted cubic splines were used to explore nonlinear relationships. Subgroup analyses were used to investigate potential differences among specific ASCVD patients. Results: A total of 2157 patients with ASCVD were included. Over a median 83-month follow-up, 887 all-cause and 300 cardiovascular deaths occurred. Each unit increase in CMI was associated with an 11.3% increased risk of all-cause mortality (HR = 1.113, 95% CI: 1.112–1.115) and a 6.4% increased risk of cardiovascular mortality (HR = 1.064, 95% CI: 1.062–1.065). There was a nonlinear J-shaped relationship between CMI and all-cause mortality, while the risk of cardiovascular mortality increased linearly with increasing CMI. Conclusions: These findings underscore the importance of monitoring and managing CMI in patients with ASCVD in clinical practice and suggest that optimizing CMI levels may help reduce the risk of death and improve the long-term prognosis of patients. Full article

Background: Accumulating evidence indicates a link between folate and metabolic dysfunction-associated fatty liver disease (MAFLD). Objectives: The aim of this study was to ascertain whether different serum folate forms are associated with newly defined MAFLD as well as liver fibrosis in the US general population. Methods: This cross-sectional study used data from the 2017–2020 (March) cycle and 2017–2018 cycle of the National Health and Nutrition Examination Survey (NHANES) in the US. Hepatic steatosis and fibrosis were evaluated by transient elastography, which employed controlled attenuation parameters and liver stiffness measurements as assessment indicators. Results: 7447 eligible individuals were included. The estimated prevalence of MAFLD and liver fibrosis was 51.6% (95% confidence interval [CI]: 50.4–52.7%) and 10.0% (95% CI: 9.3–10.7%). After adjusting for confounding factors, for every 1 nmol/L increase in serum 5-methyltetrahydrofolate (5-mTHF), the risk of developing liver fibrosis decreased by 1% (95% CI: 1–2%, p < 0.001), and the risk of developing MAFLD decreased by 1% (95% CI: 0–2%, p = 0.005). There were also significant differences in indicators such as alanine aminotransferase (ALT), gamma-glutamyl transaminase (GGT), and C-reactive protein (CRP) between the MAFLD group and the non-MAFLD group (all p values < 0.001). Conclusions: This study suggests the prevalence of MAFLD and liver fibrosis decreased significantly with the increase in serum 5-mTHF concentration. Full article

This study assessed the relationship between environmental chemical mixtures—including metals, per- and polyfluoroalkyl substances (PFAS), phthalates, and plasticizers—and key cardiovascular health markers using data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES). The combined effects of these pollutants on cardiovascular markers were evaluated using Bayesian Kernel Machine Regression (BKMR), a flexible, non-parametric modeling approach that accommodates nonlinear and interactive relationships among exposures. BKMR was applied to assess both the joint and individual associations of the chemical mixture with systolic blood pressure (SBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), diastolic blood pressure (DBP), total cholesterol, and triglycerides. As part of the BKMR analysis, posterior inclusion probabilities (PIPs) were estimated to identify the relative importance of each exposure within the mixture. These results highlighted phthalates as major contributors to LDL, SBP, total cholesterol, HDL, and triglycerides while plasticizers were associated with LDL, SBP, HDL, and triglycerides. Metals and PFAS were most strongly linked to LDL, DBP, total cholesterol, and SBP. The overall mixture effect indicated that cumulative exposures were associated with lower LDL and SBP and elevated DBP, suggesting an increased cardiovascular risk. Triglycerides exhibited a complex quantile-dependent trend, with higher exposures associated with reduced levels. These findings underscore the importance of mixture-based risk assessments that reflect real-world exposure scenarios. Full article

Introduction: Obesity is associated with cardiometabolic diseases, and chrononutrition has become a novel weight loss strategy. However, few have characterized chrononutrition patterns among people attempting weight loss. This study characterizes chrononutrition patterns in a nationally representative sample of U.S. adults who attempted weight loss in the past year through dietary modifications by weight change and adiposity. Methods: This cross-sectional analysis utilizes NHANES 2017–2020 data. Chrononutrition patterns were assessed using 24 h dietary recalls. Participants self-reported weight loss attempts in the past year and if they tried using diet modification. Weight change (loss, maintenance, and gain) was defined based on differences in current weight and weight one year prior. We used latent profile analysis and descriptive statistics. Results: The sample included 2107 participants who attempted weight loss in the past year through diet modification (median age 47; 58% women and 62% white). Individuals who gained weight (vs. loss) had longer hours between waketime and the first eating (1.78 vs. 1.62 h, p = 0.024), consumed a lower proportion of calories later in the day (43% vs. 52%, p < 0.001), and ate less frequently (5.20 vs. 5.43 episodes, p = 0.008). Participants with obesity had the shortest eating window (11.77 vs. 12.22 h, p = 0.02) despite a longer delay between waketime and the first eating (1.80 vs. 1.29 h, p < 0.001) and lower eating frequency (5.16 vs. 5.97, p < 0.001). Conclusions: Variations in eating timing, eating episodes, and caloric distribution suggest that chrononutrition may play a role in personalized weight management strategies. Full article

Background: This study investigates the combined effects of PFAS metals (PFOA and PFOS), heavy metals (lead, cadmium, and mercury), behavioral factors (smoking and alcohol consumption), and social factors (income and education) on depressive symptoms. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES 2017–2018), blood samples were analyzed to determine the exposure levels of PFOA, PFOS, lead, cadmium, and mercury, and self-reported behavioral and social factors were evaluated in relation to PHQ-9 scores among 181 adults. Results: Education was associated with lower odds of depressive symptoms (OR = 0.68, 95% CI: 0.43–1.07). Although the result was not statistically significant, the estimate suggested a potential protective effect that warranted further investigation. Bayesian Kernel Machine Regression demonstrated that heavy metals collectively had the strongest evidence for influencing depression (group PIP = 0.6508), followed by socioeconomic factors (group PIP = 0.642). Bivariate exposure–response analyses revealed complex interaction patterns whereby exposure effects varied substantially depending on co-exposure contexts. Conclusions: These findings highlight that depressive symptoms are shaped by complex interplays between environmental contaminants, behavior, and social determinants, underscoring the importance of mixture-based approaches in environmental mental health research and the need for integrated interventions addressing both environmental and social factors. Full article