AbstractObjectiveTo investigate the association between weight changes across adulthood and mortality.DesignProspective cohort study.SettingUS National Health and Nutrition Examination Survey ...(NHANES) 1988-94 and 1999-2014.Participants36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline).Main outcome measuresAll cause and cause specific mortality from baseline until 31 December 2015.ResultsDuring a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality.ConclusionsStable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.
To examine whether overall lifestyles mediate associations of socioeconomic status (SES) with mortality and incident cardiovascular disease (CVD) and the extent of interaction or joint relations of ...lifestyles and SES with health outcomes.
Population based cohort study.
US National Health and Nutrition Examination Survey (US NHANES, 1988-94 and 1999-2014) and UK Biobank.
44 462 US adults aged 20 years or older and 399 537 UK adults aged 37-73 years.
SES was derived by latent class analysis using family income, occupation or employment status, education level, and health insurance (US NHANES only), and three levels (low, medium, and high) were defined according to item response probabilities. A healthy lifestyle score was constructed using information on never smoking, no heavy alcohol consumption (women ≤1 drink/day; men ≤2 drinks/day; one drink contains 14 g of ethanol in the US and 8 g in the UK), top third of physical activity, and higher dietary quality.
All cause mortality was the primary outcome in both studies, and CVD mortality and morbidity in UK Biobank, which were obtained through linkage to registries.
US NHANES documented 8906 deaths over a mean follow-up of 11.2 years, and UK Biobank documented 22 309 deaths and 6903 incident CVD cases over a mean follow-up of 8.8-11.0 years. Among adults of low SES, age adjusted risk of death was 22.5 (95% confidence interval 21.7 to 23.3) and 7.4 (7.3 to 7.6) per 1000 person years in US NHANES and UK Biobank, respectively, and age adjusted risk of CVD was 2.5 (2.4 to 2.6) per 1000 person years in UK Biobank. The corresponding risks among adults of high SES were 11.4 (10.6 to 12.1), 3.3 (3.1 to 3.5), and 1.4 (1.3 to 1.5) per 1000 person years. Compared with adults of high SES, those of low SES had higher risks of all cause mortality (hazard ratio 2.13, 95% confidence interval 1.90 to 2.38 in US NHANES; 1.96, 1.87 to 2.06 in UK Biobank), CVD mortality (2.25, 2.00 to 2.53), and incident CVD (1.65, 1.52 to 1.79) in UK Biobank, and the proportions mediated by lifestyle were 12.3% (10.7% to 13.9%), 4.0% (3.5% to 4.4%), 3.0% (2.5% to 3.6%), and 3.7% (3.1% to 4.5%), respectively. No significant interaction was observed between lifestyle and SES in US NHANES, whereas associations between lifestyle and outcomes were stronger among those of low SES in UK Biobank. Compared with adults of high SES and three or four healthy lifestyle factors, those with low SES and no or one healthy lifestyle factor had higher risks of all cause mortality (3.53, 3.01 to 4.14 in US NHANES; 2.65, 2.39 to 2.94 in UK Biobank), CVD mortality (2.65, 2.09 to 3.38), and incident CVD (2.09, 1.78 to 2.46) in UK Biobank.
Unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.
Aims/hypothesis
A healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes. However, no systematic review has summarised the relationship between combined ...lifestyle factors (including, but not limited to, smoking, alcohol drinking, physical activity, diet and being overweight or obese) and incident type 2 diabetes and risk of health outcomes among diabetic individuals.
Methods
EMBASE and PubMed were searched up to April 2019 without language restrictions. References included in articles in relevant publications were also screened. Cohort studies investigating the combined associations of at least three lifestyle factors with incident type 2 diabetes and health outcomes among diabetic individuals were included. Reviewers were paired and independently screened studies, extracted data and evaluated study quality. Random-effects models were used to calculate summary HRs. Heterogeneity and publication bias tests were also conducted.
Results
Compared with participants considered to have the least-healthy lifestyle, those with the healthiest lifestyle had a 75% lower risk of incident diabetes (HR 0.25 95% CI 0.18, 0.35; 14 studies with approximately 1 million participants). The associations were largely consistent and significant among individuals from different socioeconomic backgrounds and baseline characteristics. Among individuals with type 2 diabetes (10 studies with 34,385 participants), the HRs (95% CIs) were 0.44 (0.33, 0.60) for all-cause death, 0.51 (0.30, 0.86) for cardiovascular death, 0.69 (0.47, 1.00) for cancer death and 0.48 (0.37, 0.63) for incident cardiovascular disease when comparing the healthiest lifestyle with the least-healthy lifestyle.
Conclusions/interpretation
Adoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals. Tackling multiple risk factors, instead of concentrating on one certain lifestyle factor, should be the cornerstone for reducing the global burden of type 2 diabetes.
Cancer poses a huge disease burden, which could be reduced by adopting healthy lifestyles mainly composed of healthy diet, body weight, physical activity, limited alcohol consumption, and avoidance ...of smoking. However, no systematic review has summarised the relations of combined lifestyle factors with cancer morbidity and mortality.
EMBASE and PubMed were searched up to April 2019. Cohort studies investigating the association of combined lifestyle factors with risks of incident cancer and cancer mortality were selected. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity and publication bias tests were conducted.
The HRs (95% CIs) comparing individuals with the healthiest versus the least healthy lifestyles were 0.71 (0.66-0.76; 16 studies with 1.9 million participants) for incident cancer and 0.48 (0.42-0.54; 30 studies with 1.8 million participants) for cancer mortality. Adopting the healthiest lifestyles was also associated with 17 to 58% lower risks of bladder, breast, colon, endometrial, oesophageal, kidney, liver, lung, rectal, and gastric cancer. The relations were largely consistent and significant among participants with different characteristics in the subgroup analyses.
Adopting healthy lifestyles is associated with substantial risk reduction in cancer morbidity and mortality, and thus should be given priority for cancer prevention.
Epidemiological and mechanistic studies have reported relationships between blood lipids, mostly measured by traditional method in clinical settings, and gestational diabetes mellitus (GDM). Recent ...advances of high-throughput lipidomics techniques have made available more comprehensive lipid profiling in biological samples. This review aims to summarize evidence from prospective studies in assessing relations between blood lipids and GDM, and discuss potential underlying mechanisms.
Mass spectrometry and nuclear magnetic resonance spectroscopy-based analytical platforms are extensively used in lipidomics research. Epidemiological studies have identified multiple novel lipidomic biomarkers that are associated with risk of GDM, such as certain types of fatty acids, glycerolipids, glycerophospholipids, sphingolipids, cholesterol, and lipoproteins. However, the findings are inconclusive mainly due to the heterogeneities in study populations, sample sizes, and analytical platforms. Mechanistic evidence indicates that abnormal lipid metabolism may be involved in the pathogenesis of GDM by impairing pancreatic β-cells and inducing insulin resistance through several etiologic pathways, such as inflammation and oxidative stress.
Lipidomics is a powerful tool to study pathogenesis and biomarkers for GDM. Lipidomic biomarkers and pathways could help to identify women at high risk for GDM and could be potential targets for early prevention and intervention of GDM.
Aims
To investigate the sex‐specific associations between predicted skeletal muscle mass index (pSMI) and incident type 2 diabetes in a retrospective longitudinal cohort of Chinese men and women.
...Materials and Methods
We enrolled Chinese adults without diabetes at baseline from WATCH (West chinA adulT health CoHort), a large health check‐up‐based database. We calculated pSMI to estimate skeletal muscular mass, and measured blood glucose variables and assessed self‐reported history to identify new‐onset diabetes. The nonlinear association between pSMI and incident type 2 diabetes was modelled using the penalized spline method. The piecewise association was estimated using segmented linear splines in weighted Cox proportional hazards regression models.
Results
Of 47 885 adults (53.2% women) with a median age of 40 years, 1836 developed type 2 diabetes after a 5‐year median follow‐up. In women, higher pSMI was associated with a lower risk of incident type 2 diabetes (Pnonlinearity = 0.09, hazard ratio HR per standard deviation increment in pSMI: 0.79 95% confidence interval {CI} 0.68, 0.91). A nonlinear association of pSMI with incident type 2 diabetes was detected in men (Pnonlinearity < 0.001). In men with pSMI lower than 8.1, higher pSMI was associated with a lower risk of incident type 2 diabetes (HR 0.58 95% CI 0.40, 0.84), whereas pSMI was not significantly associated with incident diabetes in men with pSMI equal to or greater than 8.1 (HR 1.08 95% CI 0.93, 1.25).
Conclusions
In females, a larger muscular mass is associated with a lower risk of type 2 diabetes. For males, this association is significant only among those with diminished muscle mass.
For the first time, the Chinese Government has officially endorsed a unified insurance scheme for residents in urban and rural areas, with unification of coverage, a fund pooling mechanism, a ...benefits package and reimbursement rates, a basic medical insurance drug list, unified selection of health providers, and fund management. This decision marks a commendable milestone towards universal health coverage in China. However, implementation of this integration needs special attention to some key points.
Background The aim of this study was to identify associations between dietary intakes of eggs and cholesterol and all-cause and heart disease mortality in a US population. Methods and Results Data ...from the National Health and Nutrition Examination Survey 1999-2014 were used in this study, which included 37 121 participants ≥20 years of age. Dietary information was assessed via 24-hour dietary recalls at baseline. Mortality status was documented until December 31, 2015. Cox proportional hazards models were used to examine the associations between dietary intakes of eggs and cholesterol and all-cause and heart disease mortality. During a median follow-up of 7.8 years, 4991 deaths were documented, including 870 deaths from heart disease. No significant association was observed between additional daily consumption of half an egg and all-cause mortality (multivariable-adjusted hazard ratio, 1.04; 95% CI, 0.96-1.13), or heart disease mortality (0.96; 0.80-1.14). Each 50-mg/day increase of cholesterol intake was inversely associated with all-cause mortality among participants with daily intake <250 mg (0.87; 0.77-0.98), but positively associated with all-cause mortality among participants with daily intake ≥250 mg (1.07; 1.01-1.12). No significant association was found between dietary cholesterol intake and heart disease mortality. Conclusions No significant association was found between egg consumption and mortality in US adults. The association between dietary cholesterol intake and all-cause mortality depended on the baseline intake levels, with an inverse association in those with lower intake levels (<250 mg/day) but a positive association in those with higher intake levels (≥250 mg/day).
Aims
We prospectively examined the relationship between metabolic syndrome (MetS) and incident chronic kidney disease (CKD) among middle‐aged and elderly Chinese, and conducted a systematic review ...and meta‐analysis of all cohort studies on this topic.
Materials and Methods
Our research data were derived from the China Health and Retirement Longitudinal Study. Participants (n=5752, age ≥45 years) without CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73m2) at baseline were followed up for 4 years. We applied logistic regressions to examine the association of MetS with incident CKD. In addition, we pooled our effect estimates and those from previous cohort studies in the meta‐analysis.
Results
In a 4‐years follow‐up, 61 (4.27%) developed CKD in participants with MetS versus 102 (2.36%) in participants without MetS. After adjustment for potential confounders, odds ratio for incident CKD was 1.82 95% confidence interval (95% CI): 1.19–2.78 comparing participants with MetS with those without MetS. There was a linear positive association between the number of MetS components and incident CKD (p for trend <0.001). In the updated meta‐analysis of 25 studies among 350,655 participants with 29,368 incident cases of CKD, the pooled relative risk of developing CKD in participants with MetS was 1.34 (95% CI: 1.28–1.39), compared with those without MetS.
Conclusions
Individuals with MetS had higher risk of incident CKD in middle‐aged and elderly Chinese adults, which was supported by a comprehensive review of cohort studies from multiple populations. It may be advisable to routinely monitor renal functions among individuals with MetS.
•3-phenoxybenzoic acid, as an indicator of pyrethroids, was associated adversely associated with cardiovascular disease and stroke in the US adults.•The associations seemed to be linear for both ...cardiovascular disease and stroke.•Our findings may highlight the need for routine monitoring of pyrethroids exposure and its health impacts in the population.
Pyrethroids-containing products are widely used as commercial and household insecticides. While animal studies and clinical case reports have shown acute cardiovascular outcomes of pyrethroids exposure, little has been known on the effect of chronic pyrethroid exposure on cardiovascular disease (CVD). We aimed to examine the associations between chronic pyrethroid exposure and CVD in the US adults.
Cross-sectional data from the National Health and Nutrition Examination Survey 1999–2002 and 2007–2012 were analyzed. The exposure to pyrethroids was determined as the urinary level of 3-phenoxybenzoic acid (3-PBA), and CVD was ascertained based on self-reported physician diagnoses. Multivariable logistic regression models were fitted to evaluate associations of pyrethroid exposure with CVD, coronary heart disease (CHD), and stroke.
Included were 6,471 participants with a mean age of 44.77 years (standard error, 0.39) for final analyses. The weighted prevalence of CVD, CHD, and stroke was 6.85%, 4.57% and 2.27%, respectively. With adjustments for major confounders, participants in the highest tertile of urinary 3-PBA had higher odds of CVD (odds ratio, 1.58; 95% confidence interval: 1.12, 2.23) and CHD (OR, 1.75; 95% CI: 1.17, 2.61) compared to those in the lowest tertile. There were linear associations for CVD (P for trend = 0.04) and CHD (P for trend = 0.02). However, no significant association was noted for stroke (1.29; 0.78, 2.16) in the main analyses.
3-PBA was adversely associated with CVD and CHD in the US adults. Our findings highlight potential cardiovascular risk of chronic exposure to pyrethroids, and should be validated in large prospective studies in different populations in future.
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