The Association of Different Sedentary Patterns and Health-Related Physical Fitness in Pre-schoolers

Background: The results of sedentary time (ST) and health-related physical fitness (HPF) are not completely consistent and the studies concentrated on pre-schoolers are very limited.Methods: We measured ST and ST patterns (ST Bouts time, ST Breaks times) by accelerometer. The health-related physical fitness T-score (HPFT) was calculated by five indexes: height-weight standard score, 20 m shuttle-run test, grip strength, standing long jump and 2 × 10 m shuttle-run test.Results: We included 375 pre-schoolers (211 boys, 164 girls) in the final analysis. The total ST and ST Bouts times negatively correlated with HPFT in pre-schoolers. HPFT reduced by 1.69 and 0.70 points per 10 min increased in total ST and ST Bouts times, respectively. HPFT of the highest quartile group reduced by 9.85 points in total ST, and 10.54 points in ST Bouts time compared with the lowest quartile group. However, the HPFT increased by 0.09 points per 10 times increased in ST Breaks times; the HPFT increased by 16.21 and 15.59 points when moderate to vigorous physical activity (MVPA) replaced total ST and ST Bouts time.Conclusions: HPF negatively correlated with the Total ST and ST Bouts times, but positively correlated with ST Breaks times; and HPF significantly improved when MVPA replaced ST in pre-schoolers.

Association Between Neutrophil–Lymphocyte Ratio and Frailty: The Chinese Longitudinal Healthy Longevity Survey

Background: Inflammation has been reported to play an important role in frailty syndrome. The neutrophil–lymphocyte ratio (NLR) has recently emerged as an informative marker for systematic inflammation. However, few studies have examined the association between NLR and frailty. This study aims to examine the association between NLR and frailty in community-dwelling older adults.Methods: Community-dwelling older adults aged ≥ 65 years in the 2011 (n = 2,354) and 2014 (n = 2,458) waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Frailty status was determined using the 38-item frailty index (FI) and categorized into “robust” (FI ≤ 0.1), “pre-frail” (0.1 < FI ≤ 0.21), or “frail” (FI > 0.21). NLR was calculated using a derived formula: NLR = (white blood cell–lymphocyte)/lymphocyte.Results: A total of 3,267 participants were finally included. In cross-sectional analyses, participants with higher NLR levels had increased likelihood of frailty [the 3rd quartile: adjusted odds ratio (OR) = 1.29; 95% confidence interval (CI): 1.02–1.63; the 4th quartile: OR = 1.59; 95% CI: 1.23–2.02) compared with those in the 1st quartile group. During the 3-year follow-up, 164 of the 1,206 participants, robust or pre-frail at baseline, developed frailty, and 197 of the 562 participants, robust at baseline, developed pre-frailty or frailty. Among the robust and pre-frail participants in 2011, after multivariate adjustment, those in the 4th quartile group had a higher frailty incidence than those in the 1st quartile group (OR = 2.06; 95% CI: 1.18–3.59). Among the robust participants in 2011, those in the 4th quartile group also had a higher pre-frailty or frailty incidence than those in the 1st quartile group (OR = 1.95; 95% CI: 1.07–3.55).Conclusion: Among community-dwelling older adults, higher NLR levels were found to be associated with increased odds of prevalent and incident frailty.

High Bodyweight Variability Increases Depression Risk in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study in Korea

Objectives: Although obesity is associated with increased risk for depression in patients with type 2 diabetes mellitus (DM), the relationship between body weight variability (BWV) and depression remains poorly studied. This study was to investigate the incidence of depression in patients with type 2 DM according to their BWV.Methods: Intraindividual variation in body weight were measured in the nationwide, population-based retrospective cohort of 540,293 patients with type 2 DM from the Korean national health insurance system between 2009 and 2010. The diagnoses of new-onset depression occurring until the end of 2017 were ascertained. Risk of new-onset depression was examined using multivariate-adjusted Cox proportional hazards regression analysis by BWV quartile.Results: 93,149 (17.2%) patients developed new-onset depression for the follow up. BWV was significantly associated with an increased risk of depression after adjusting for confounding factors. The highest BWV quartile group had a hazard ratio (HR) of 1.17 (95% CI 1.15–1.19) compared to the lowest BWV quartile group as a reference. Obese patients in the highest BWV quartile group showed 12% increased risk of depression (HR 1.12, 95% CI 1.09–1.15) while non-obese patients in the highest BWV quartile group showed 20% increased risk of depression (HR: 1.20, 95% CI: 1.17–1.23) compared to their respective lowest BWV quartile groups.Conclusion: A higher BWV was significantly associated with an increased risk of depression in patients with type 2 DM. Thus, BWV may serve as an indicator for early detection of depression in type 2 DM patients.

Dialysis Adequacy and Risk of Dementia in Elderly Hemodialysis Patients

Objective: Dementia is prevalent among elderly patients undergoing hemodialysis. However, the association between dialysis adequacy and the risk of dementia is uncertain.Methods: A total of 10,567 patients aged >65 years undergoing maintenance hemodialysis who participated in a national hemodialysis quality assessment program were analyzed. The patients were classified into quartile groups based on single-pool Kt/V levels. The associations between single-pool Kt/V and the development of dementia, Alzheimer's disease (AD), and vascular dementia (VD) were examined.Results: The mean age of the patients was 72.9 years, and 43.4% were female. The mean baseline single-pool Kt/V level was 1.6 ± 0.3. During a median follow-up of 45.6 (45.6–69.9) months, there were 27.6, 23.9, and 2.8 events/1,000 person-years of overall dementia, AD, and VD, respectively. The incidences of overall dementia, AD, and VD were lowest in the highest single-pool Kt/V quartile group. Compared with the lowest single-pool Kt/V quartile, the risks of incident overall dementia and AD were significantly lower in the highest quartile [sub-distribution hazard ratio (sHR): 0.69, 95% confidence interval (CI): 0.58–0.82 for overall dementia; sHR: 0.69, 95% CI: 0.57–0.84 for AD]. Inverse relationships were found between the risks of developing overall dementia and AD, and single-pool Kt/V. However, no significant relationship was observed between single-pool Kt/V levels and VD development.Conclusions: Increased dialysis clearance was associated with a lower risk of developing dementia in elderly hemodialysis patients.

Blood pressure variability and the risk of fracture: a nationwide cohort study

Context Although blood pressure variability (BPV) is associated with various health outcomes, only one study suggested that BPV is correlated with hip fractures. As cardiovascular disease and fractures share similar pathophysiology, there might be a link between BPV and fractures. Objective To investigate the association between BPV and the incident fractures. Design Retrospective cohort study. Setting Population-based, using the Korean National Health Insurance System database. Patients or Other Participants A total of 3,256,070 participants aged 50 and above who participated in ≥3 health examinations within the previous five years, including the index year (2009-2010), were included. Outcome data was obtained through the end of 2016. Exposure BPV was calculated using variability independent of the mean. High variability was defined as the highest quartile of variability. Main Outcome Measures Newly diagnosed fractures. Results During the median follow-up of 7.0 years, there were 337,045 cases of any fracture (10.4%). After adjusting for age, sex, income, lifestyle factors, and comorbidities, a higher risk of fracture was observed with higher quartiles of BPV than the lowest quartile group: the adjusted hazard ratios (95% confidence intervals) for incident any fracture were 1.07 (1.06–1.08) in the higher quartile of systolic BPV, 1.06 (1.05–1.07) in that of diastolic BPV, and 1.07 (1.06–1.08) in that of both systolic and diastolic BPV. Consistent results were noted for vertebral fractures and hip fractures, as well as in various subgroup analyses. Conclusions A positive association was noted between higher BPV and fracture incidence. BPV is an independent predictor for developing fracture.

Increased risk of type 2 diabetes in patients with thyroid cancer after thyroidectomy: A nationwide cohort study

Context Abnormal thyroid function after thyroidectomy and subsequent thyroid-stimulating hormone suppression can have detrimental effects on glucose homeostasis in thyroid cancer patients. Objective To investigate whether thyroidectomy increases the risk of type 2 diabetes in thyroid cancer patients and to explore the association between levothyroxine dosage and type 2 diabetes risk. Design A retrospective population-based cohort study. Setting The Korean National Health Insurance database. Participants We included 36,377 thyroid cancer patients without known diabetes who underwent thyroidectomy between 2004 and 2013. Matched non-thyroid cancer subjects were selected using 1:1 propensity score matching. Main Outcome Measure Newly developed type 2 diabetes mellitus. Results Thyroid cancer patients who underwent thyroidectomy had a higher risk of developing type 2 diabetes mellitus than the matched controls (hazard ratio [HR]: 1.43, 95% confidence interval [CI]: 1.39–1.47). Among thyroid cancer patients, when the second quartile group (in terms of the mean levothyroxine dosage; 101–127 μg/day) was considered the reference group, the risk of type 2 diabetes mellitus increased in the first quartile (<101 μg/day; HR: 1.45, 95% CI: 1.36–1.54) and fourth quartile groups (≥150 μg/day; HR: 1.37, 95% CI: 1.29–1.45); meanwhile, the risk decreased in the third quartile group (128–149 μg/day; HR: 0.91, 95% CI: 0.85–0.97). Conclusion Thyroid cancer patients who underwent thyroidectomy were more likely to develop type 2 diabetes mellitus than the matched controls. There was a U-shaped dose-dependent relationship between the levothyroxine dosage and type 2 diabetes mellitus risk.

The Plasma Atherogenic Index is an Independent Predictor of Arterial Stiffness in Healthy Koreans

The plasma atherogenic index (AIP) has been suggested as a useful independent predictor of cardiovascular diseases (CVDs) in high CV risk patients. We investigated the association between AIP and arterial stiffness measured by brachial–ankle pulse wave velocity (baPWV) in healthy adults. A total of 3468 healthy subjects without any metabolic or CV diseases were enrolled. Anthropometric and CV risk factors were measured. The AIP was defined as the base 10 logarithm of the ratio of the concentration of triglycerides to high-density lipoprotein-cholesterol. Subjects were classified into AIP quartiles. There were gradual deteriorations in metabolic parameters and increase in baPWV across the increasing AIP quartiles. In a fully adjusted analysis, compared with Q1 (lowest quartile) group, the odds ratio (95% confidence interval) for increased baPWV was higher in Q2 1.51, Q3 1.64, and Q4 (highest quartile) 2.77 among men, and Q2 1.09, Q3 1.55, and Q4 1.83 among women (all P trend <0 .05). There was a strong association between AIP and baPWV, and a higher AIP was an independent predictor of increased arterial stiffness in healthy Korean men and women. The AIP may be a simple screening tool for subclinical atherosclerosis.

High Blood Uric Acid Is Associated With Reduced Risks of Mild Cognitive Impairment Among Older Adults in China: A 9-Year Prospective Cohort Study

Background: It remains unsolved that whether blood uric acid (UA) is a neuroprotective or neurotoxic agent. This study aimed to evaluate the longitudinal association of blood UA with mild cognitive impairment (MCI) among older adults in China.Methods: A total of 3,103 older adults (aged 65+ years) free of MCI at baseline were included from the Healthy Aging and Biomarkers Cohort Study (HABCS). Blood UA level was determined by the uricase colorimetry assay and analyzed as both continuous and categorical (by quartile) variables. Global cognition was assessed using the Mini-Mental State Examination four times between 2008 and 2017, with a score below 24 being considered as MCI. Cox proportional hazards models were used to examine the associations.Results: During a 9-year follow-up, 486 (15.7%) participants developed MCI. After adjustment for all covariates, higher UA had a dose-response association with a lower risk of MCI (all Pfor trend &lt; 0.05). Participants in the highest UA quartile group had a reduced risk [hazard ratio (HR), 0.73; 95% (CI): 0.55–0.96] of MCI, compared with those in the lowest quartile group. The associations were still robust even when considering death as a competing risk. Subgroup analyses revealed that these associations were statistically significant in younger older adults (65–79 years) and those without hyperuricemia. Similar significant associations were observed when treating UA as a continuous variable.Conclusions: High blood UA level is associated with reduced risks of MCI among Chinese older adults, highlighting the potential of managing UA in daily life for maintaining late-life cognition.

Baseline homeostasis model assessment of insulin resistance associated with fibrosis progression in patients with nonalcoholic fatty liver disease without diabetes: A cohort study

Background and aims Fibrosis progression is the most important prognostic factor, and insulin resistance is one of the main mechanisms associated with fibrosis progression in patients with nonalcoholic fatty liver disease (NAFLD). We evaluate the association between baseline insulin resistance and future fibrosis progression in patients with NAFLD without diabetes. Approach and results This retrospective longitudinal study with 8-year follow-up period included 32,606 (men, 83%) participants aged >20 years (average age, 38.0 years) without diabetes at baseline who completed at least two comprehensive health checkups from January 1, 2010 to December 31, 2018. NAFLD was diagnosed based on ultrasonography. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate baseline insulin resistance. Fibrosis progression was assessed using the aspartate aminotransferase to platelet ratio index (APRI). The advanced liver fibrosis with an APRI value above the intermediate fibrosis probability (≥0.5) developed in a total of 2,897 participants during 136,108 person-years. 114 participants progressed to a high fibrosis probability stage (APRI >1.5) during 141,064 person-years. Using the lowest baseline HOMA-IR quartile group (Q1) as a reference, the multivariate-adjusted hazard ratio (HR) for development of advanced liver fibrosis (APRI ≥0.5) in the highest baseline HOMA-IR quartile group (Q4) was 1.95 (95% confidence interval [CI] 1.74–2.19; Model 4). And the HR for development of advanced liver fibrosis with high fibrosis probability was 1.95 (95% CI 1.10–3.46; Model 4). The positive association was maintained throughout the entire follow-up period. The baseline HOMA-IR model was superior to the baseline body mass index (BMI) model in predicting the progression of fibrosis probability. Conclusions In this longitudinal study, we found that the degree of baseline insulin resistance, assessed by HOMA-IR values, was positively associated with future fibrosis progression in patients with NAFLD without diabetes.

Impact of Plasmatic Progesterone on the Day of Frozen Embryo Transfer in Hormone-induced Cycles

Objective To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. Methods This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were β human chorionic gonadotropin (β-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. Results A total of 140 transfers were included in the analysis: 87 with β-HCG > 10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%). Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher β-HCG-positive (72 versus 59%; p > 0.05), lower delivery (26 versus 39%; p > 0.05) and higher miscarriage rates (64 versus 33%; p < 0.01). Comparing the middle quartiles (P25–50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p > 0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p > 0.05) and a lower number of miscarriages (28 versus 45%; p > 0.05). These differences were not statistically significant. Conclusion There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.