Proton pump inhibitors and all-cause mortality risk among cancer patients

BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.

Triceps skinfold thickness trajectories and the risk of all-cause mortality:A prospective cohort study

BACKGROUND The measurement of triceps skinfold(TSF)thickness serves as a noninvasive metric for evaluating subcutaneous fat distribution.Despite its clinical utility,the TSF thickness trajectories and their correlation with overall mortality have not been thoroughly investigated.AIM To explore TSF thickness trajectories of Chinese adults and to examine their associations with all-cause mortality.METHODS This study encompassed a cohort of 14747 adults sourced from the China Health and Nutrition Survey.Latent class trajectory modeling was employed to identify distinct trajectories of TSF thickness.Subjects were classified into subgroups reflective of their respective TSF thickness trajectory.We utilized multivariate Cox regression analyses and mediation examinations to explore the link between TSF thickness trajectory and overall mortality,including contributory factors.RESULTS Upon adjustment for multiple confounding factors,we discerned that males in the‘Class 2:Thin-stable’and‘Class 3:Thin-moderate’TSF thickness trajectories exhibited a markedly reduced risk of mortality from all causes in comparison to the‘Class 1:Extremely thin’subgroup.In the mediation analyses,the Geriatric Nutritional Risk Index was found to be a partial intermediary in the relationship between TSF thickness trajectories and mortality.For females,a lower TSF thickness pattern was significantly predictive of elevated all-cause mortality risk exclusively within the non-elderly cohort.CONCLUSION In males and non-elderly females,lower TSF thickness trajectories are significantly predictive of heightened mortality risk,independent of single-point TSF thickness,body mass index,and waist circumference.

Association between inflammatory bowel disease and all-cause dementia:A two-sample Mendelian randomization study

BACKGROUND Numerous observational studies have documented a correlation between inflammatory bowel disease(IBD)and an increased risk of dementia.However,the causality of their associations remains elusive.AIM To assess the causal relationship between IBD and the occurrence of all-cause dementia using the two-sample Mendelian randomization(MR)method.METHODS Genetic variants extracted from the large genome-wide association study(GWAS)for IBD(the International IBD Genetics Consortium,n=34652)were used to identify the causal link between IBD and dementia(FinnGen,n=306102).The results of the study were validated via another IBD GWAS(United Kingdom Biobank,n=463372).Moreover,MR egger intercept,MR pleiotropy residual sum and outlier,and Cochran's Q test were employed to evaluate pleiotropy and heterogeneity.Finally,multiple MR methods were performed to estimate the effects of genetically predicted IBD on dementia,with the inverse variance weighted approach adopted as the primary analysis.RESULTS The results of the pleiotropy and heterogeneity tests revealed an absence of significant pleiotropic effects or heterogeneity across all genetic variants in outcome GWAS.No evidence of a causal effect between IBD and the risk of dementia was identified in the inverse variance weighted[odds ratio(OR)=0.980,95%CI:0.942-1.020,P value=0.325],weighted median(OR=0.964,95%CI:0.914-1.017,P value=0.180),and MR-Egger(OR=0.963,95%CI:0.867-1.070,P value=0.492)approaches.Consistent results were observed in validation analyses.Reverse MR analysis also showed no effect of dementia on the development of IBD.Furthermore,MR analysis suggested that IBD and its subtypes did not causally affect allcause dementia and its four subtypes,including dementia in Alzheimer's disease,vascular dementia,dementia in other diseases classified elsewhere,and unspecified dementia.CONCLUSION Taken together,our MR study signaled that IBD and its subentities were not genetically associated with all-cause dementia or its subtypes.Further large prospective studies are warranted to elucidate the impact of intestinal inflammation on the development of dementia.

Effect of Body Mass Index on All-cause Mortality and Incidence of Cardiovascular Diseases─Report for Meta-Analysis of Prospective Studies on Optimal Cut-off Points of Body Mass Index in Chinese Adults

Objective To verify the optimal cut-off points for overweight and obesity in Chinese adults based on the relationship of baseline body mass index (BMI) to all-cause mortality, and incidence of cardiovascular diseases from pooled data of Chinese cohorts. Methods The prospective study data of existing cohort studies in China were collected, and the age-adjusted all-cause mortality stratified by BMI were estimated. The similar analysis was repeated after excluding deaths within the first three years of follow-up and after excluding smokers. The incidence of age-adjusted coronary heart disease (CHD) and stroke stratified by BMI were also analyzed. Multiple Cox regression coefficients of BMI for the incidence of CHD and stroke after controlling other risk factors were pooled utilizing the methods of weighting by inverse of variance to reveal whether BMI had independent effect and its strength on the incidence of CHD and stroke. Results The data of 4 cohorts including 76 227 persons, with 745 346 person-years of follow-up were collected and analyzed. The age-adjusted all-cause mortality stratified by BMI showed a U-shaped curve, even after excluding deaths within the first three years of follow-up and excluding smokers. Age-adjusted all-cause mortality increased when BMI was lower than 18.5 and higher than 28. The incidence of CHD and stroke, especially ishemic stroke increased with increasing BMI, this was consistent with parallel increasing of risk factors. Cox regression analysis showed that BMI was an independent risk factor for both CHD and stroke. Each amount of 2 kg/m2 increase in baseline BMI might cause 15.4%, 6.1% and 18.8 % increase in relative risk of CHD, total stroke and ischemic stroke. Reduction of BMI to under 24 might prevent the incidence of CHD by 11% and that of stroke by 15 % for men, and 22 % of both diseases for women. Conclusion BMI ≤18.5, 24-27.9 and ≥28 (kg/m2) is the appropriate cut-off points for underweight, overweight and obesity in Chinese adults.

The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease

Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation： AG = Na^＋ [（mmol/L） ＋ K^＋ （mmol/L）] - [Cl^- （mmol/L） ＋ HCO3^- （mmol/L）]. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD （P 〈 0.001） and worse cardiac function （P = 0.004）. Patients in the 4th quartile of serum AG （≥ 15.92 mmol/L） had a 5.171-fold increased risk of 30 days all-cause death （P 〈 0.001）. This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio （HR）： 4.861, 95% confidence interval （CI）： 2.150–10.993, P 〈 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders （HR： 3.318, 95% CI： 1.76–2.27, P = 0.009）. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.

Adverse associations of sedentary behavior with cancer incidence and all-cause mortality:A prospective cohort study

Background:Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality,and evidence from the Chinese population is scarce.This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity(MVPA)on these relationships.Methods:We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire.Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for cancer and mortality were estimated using Cox proportional hazards regression models.Results:During 559,002 person-years of follow-up,2388 cancer events,1571 cancer deaths,and 4562 all-cause deaths were recorded.Sedentary behavior was associated with increased risk of developing cancer and deaths in a doseresponse manner.The multivariable-adjusted HRs(95%CIs)were the following:HR=1.16,95%CI:1.01-1.33;HR=1.24,95%CI:1.04-1.48;and HR=1.15,95%CI:1.04-1.28 for cancer incidence,cancer mortality,and all-cause mortality,respectively,for those having≥10 h/day of sedentary time compared with those having<6 h/day of sedentary time.Sedentary populations(≥10 h/day)developed cancer or died 4.09 years and 2.79 years earlier,respectively,at the index age of 50 years.Failure to achieve the recommended level of MVPA may further aggravate the adverse associations,with the highest cancer and mortality risks being observed among participants with both≥10 h/day of sedentary time and<150 min/week of MVPA.Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.Conclusion:Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults,especially for those with≥10 h/day of sedentary time.It is necessary to reduce sedentary time,in addition to increasing MVPA levels,for the prevention of cancer and premature death.

BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing： a 20-year Cohort Study

Objective To explore the association between body mass index （BMI） and all-cause mortality among the elderly in Beijing. Methods This analysis was based on the Beijing multidimensional longitudinal study of aging （BLSA）, which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012. BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality. Cox proportional hazard models were used to obtain the hazard ratios （HRs） for BMI and BMI changes in the overall population and in specific stratified populations. Results During follow-up, 2,264 deaths were recorded; BMI-mortality curve was U-shaped, with the lowest mortality at a BMI of approximately 25 kg/m2. After adjusting for gender, age, smoking, drinking and some pre-existing diseases, HRs for underweight, overweight and obesity compared with normal weight were 2.372 （95% C/： 2.254-2.632）, 0.767 （95% CI： 0.666-0.884） and 0.872 （95% CI： 0.830-1.246）, respectively. HR for BMI drop was 3.245 （95% CI： 0.824-22.772） in the underweight group and 1.892 （95% C/： 0.830-1.246） in the normal weight group, HR for BMI rise was 1.795 （95% CI： 1.243-2.591） in normal weight group and 2.962 （95% CI： 2.202-3.203） in the overweight group. Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality

Abdominal Obesity and Its Attribution to All-cause Mortality in the General Population with 14 Years Follow-up:Findings from Shanxi Cohort in China

Objective This study aimed to assess the association of waist circumference(WC)with all-cause mortality among Chinese adults.Methods The baseline data were from Shanxi Province of 2002 China Nutrition and Health Survey.The death investigation and follow-up visit were conducted from December 2015 to March 2016.The visits covered up to 5,360 of 7,007 participants,representing a response rate of 76.5%.The Cox regression model and floating absolute risk were used to estimate hazard ratio and 95%floating CI of death by gender and age groups(≥60 and<60 years old).Sensitivity analysis was performed by excluding current smokers;participants with stroke,hypertension,and diabetes;participants who accidentally died;and participants who died during the first 2 years of follow-up.Results This study followed 67,129 person-years for 12.5 years on average,including 615 deaths.The mortality density was 916 per 100,000 person-years.Low WC was associated with all-cause mortality among men.Multifactor-adjusted hazard ratios(HR)were 1.60(1.35–1.90)for WC<75.0 cm and 1.40(1.11–1.76)for WC ranging from 75.0 cm to 79.9 cm.Low WC(<70.0 cm and 70.0–74.9 cm)and high WC(≥95.0 cm)groups had a high risk of mortality among women.The adjusted HRs of death were 1.43(1.11–1.83),1.39(1.05–1.84),and 1.91(1.13–3.22).Conclusion WC was an important predictor of death independent of body mass index(BMI).WC should be used as a simple rapid screening and predictive indicator of the risk of death.

Fatty liver disease:Disparate predictive ability for cardiometabolic risk and all-cause mortality

AIM: To assess the association of a surrogate of fatty liver disease(FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index(FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease(CHD), and all-cause mortality.RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormonebinding globulin. In adjusted Cox models, FLD was(with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio(HR) = 1.72, 95% confidence interval(CI): 1.17-2.53] and men(HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. Allcause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.

Relationship between pulmonary hypertension and cardiovascular events, all-cause death in maintenance hemodialysis patients

Objective: To determine the impact of pulmonary hypertension (PH) on maintenance hemodialysis (MHD) patients' cardiovascular events and all-cause mortality. Methods: We included 90 MHD patients, divided into group with PH and group without PH. All patients had been followed up for 4 years, and the primary endpoints were all cause mortality and cardiovascular events. We compared the clinical data and the endpoint events between the two groups. Results: We found PH in 37 patients (41.11%). The incidence of previous cardiovascular disease in group with PH was significantly higher than that in group without PH (χ2=2.034, P < 0.05). The left atrial diameter in group with PH was significantly higher than that in group without PH (t = 7.265, P < 0.01). Logistic regression analysis revealed that previous cardiovascular disease and left atrial diameter were the independent determinants of PH. The rate of new cardiovascular events in group with PH(59.5%) was significantly higher than that in group without PH(34%) (χ2=9.203, P < 0.05). The associated variables of cardiovascular events were:systolic pulmonary arterial pressure, age, history cardiovascular disease, hs-CRP, ejection fraction, left ventricular diastolic dysfunction. In a multivariate model, the PH maintained its independent association. The mortality rate in group with PH (48.6%) was significantly higher than that in group without PH (26.4%) (χ2=5.049, P <0.05). In the Cox survival analysis, we found an association between mortality and systolic pulmonary arterial pressure, age, previous cardiovascular disease, Alb, ejection fraction. In a multivariate model the PH remains as independent predictor of mortality. Conclusion:Pulmonary hypertension is common in HD patients and a valuable predictor of mortality and cardiovascular events.

Elevated serum uric acid level as a predictor for cardiovascu-lar and all-cause mortality in Chinese patients with high cardiovascular risk

Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai and Beijing,who were inpatients with high cardiovascular(CV) risk at baseLine (2004.7 to 2005.1),and blood was taken.Follow-up for death from cardiovascular disease and any cause was complete until January 1,2006.Results The mean follow-up was 1 years.There were 303 deaths during follow-up,of which 121 were cardiovascular.Crude mortality rates were 8.3 % for all patients,6.8% for female patients (116/1715),and 9.7% (187/1933) for male patients.Among men,patients in the lower and higher uric acid groups had increased cardiac and overall mortality risks compared with patients in the normal uric acid groups.Similar relation was found in women but not statistically significant.After adjusting for other conventional risk factors (age,diabetes,hypertension,diuretic use and smoking),baseline uric acid level was still associated with increased risk for death from cardiovascular disease (P=0.005),or death from all causes (P=0.014) Conclusion Our data suggest that abnormal serum uric acid levels are independently and significantly associated with risk of cardiovascular and all-cause mortality.(J Geriatr Cardiol 2008;5:15-20)

Physical activity,fitness and all-cause mortality:An 18-year follow-up among old people

Background：Little is known about change in physical activity（PA） and its relationship to all-cause mortality among old people.There is even less information about the association between PA,fitness and all-cause mortality among people aged 80 years and above.The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality,and fitnes as a mediator of this association,among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period.Methods：Using Evergreen Project data（started in 1989）,4 study groups were formed according to self-reported changes in PA level,over a 5-year period（starting in 1989–1990 and ending in 1994–1995）：remained active（RA,control group）,changed to inactive（CI）,remained inactive（RI）,and changed to active（CA）.Mortality was followed up over the 18-year period（1994–2012）.Cox models with different covariates such as age,sex,use of alcohol,smoking,chronic diseases,and a 10 m walking test were used to analyze the association between change in PA level and mortality.Results：Compared to RA,those who decreased their PA level（CI） between baseline and follow-up had higher all-cause mortality（hazard ratio（HR=2.09;95%CI：1.63–2.69） when adjusted for age,gender,and chronic diseases.RI showed the highest all-cause mortality（HR = 2.16;95%CI：1.59–2.93）.In CA,when compared against RA,the risk of all-cause mortality was not statistically significan（HR=1.51;95%CI：0.95–2.38）.In comparison with RA,when walking speed over 10 m was added as a covariate,all-cause mortality risk was almost statistically significan only in CI（HR=1.37;95%CI：1.00–1.87）.Conclusion：Persistence and change in PA level was associated with mortality.This association was largely explained by fitnes status.Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people.

The relationships between step count and all-cause mortality and cardiovascular events:A doseresponse meta-analysis

Background:A goal of 10,000 steps per day is widely advocated,but there is little evidence to support that goal.Our purpose was to examine the doseresponse relationships between step count and all-cause mortality and cardiovascular disease risk.Methods:Cochrane Central Register of Controlled Trials,EMBASE,OVID,PubMed,Scopus,and Web of Science databases were systematically searched for studies published before July 9,2021,that evaluated the association between daily steps and at least 1 outcome.Results:Sixteen publications(12 related to all-cause mortality,5 related to cardiovascular disease;and 1 article contained 2 outcomes:both allcause death and cardiovascular events)were eligible for inclusion in the meta-analysis.There was evidence of a nonlinear doseresponse relationship between step count and risk of all-cause mortality or cardiovascular disease(p=0.002 and p=0.014 for nonlinearity,respectively).When we restricted the analyses to accelerometer-based studies,the third quartile had a 40.36%lower risk of all-cause mortality and a 35.05%lower risk of cardiovascular event than the first quartile(all-cause mortality:Q1=4183 steps/day,Q3=8959 steps/day;cardiovascular event:Q1=3500 steps/day,Q3=9500 steps/day;respectively).Conclusion:Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults,with nonlinear doseresponse patterns.

Associations between aerobic and muscle-strengthening physical activity,sleep duration,and risk of all-cause mortality:A prospective cohort study of 282,473 U.S.adults

Purpose:To examine the joint associations between meeting guidelines for physical activity(PA)and sleep duration and all-cause mortality risk among adults.Methods:Participants were adults(n=282,473)aged 18-84 years who participated in the 2004-2014 U.S.National Health Interview Survey.Mortality status was ascertained using the National Death Index through December 2015.Self-reported PA(Active:meeting both aerobic(AER)and muscle-strengthening(MSA)guidelines,AER only(AER),MSA only(MSA),or not meeting either AER or MSA(Inactive))and sleep duration(Short,recommended(Rec),or Long)were classified according to guidelines,and 12 PA-sleep categories were derived.Adjusted hazard ratios and 95%confidence intervals(95%CIs)for all-cause mortality risk were estimated using Cox proportional hazards regression models.Results:A total of 282,473 participants(55%females)were included;18,793 deaths(6.7%)occurred over an average follow-up of 5.4 years.Relative to the Active-Rec group,all other PA-sleep groups were associated with increased mortality risk except for the Active-Short group(hazard ratio=1.08;95%CI:0.92-1.26).The combination of long sleep with either MSA or Inactive appeared to be synergistic.For a given sleep duration,mortality risk progressively increased among participants classified as AER,MSA,and Inactive.Within each activity level,the mortality risk was greatest among adults with long sleep.Conclusion:Relative to adults meeting guidelines for both PA and sleep duration,adults who failed to meet guidelines for both AER and muscle strengthening PA and who also failed to meet sleep duration guidelines had elevated all-cause mortality risks.These results support interventions targeting both PA and sleep duration to reduce mortality risk.

Association between the Khorana risk score and all-cause mortality in Japanese patients with gastric and colorectal cancer: A retrospective cohort study

BACKGROUND The Khorana risk score(KRS)has poor predictive value for cancer-associated thrombosis in a single tumor type but is associated with early all-cause mortality from cancer.Evidence for the association between KRS and all-cause mortality in Japanese patients with gastric and colorectal cancer is limited.AIM To investigate whether KRS was independently related to all-cause mortality in Japanese patients with gastric and colorectal cancer after adjusting for other covariates and to shed light on its temporal validity.METHODS Data from Dryad database were used in this study.Patients in the Gastroen-terology Department of Sapporo General Hospital,Sapporo,Japan,were enrolled.The starting and ending dates of the enrollment were January 1,2008 and January 5,2015,respectively.The cutoff date for follow-up was May 31,2016.The inde-pendent and dependent(target)variables were the baseline measured using the KRS and final all-cause mortality,respectively.The KRS was categorized into three groups:Low-risk group(=0 score),intermediate-risk group(1-2 score),and high-risk group(≥3 score).RESULTS Men and patients with Eastern Cooperative Oncology Group Performance Status(ECOG PS)≥2 displayed a higher 2-year risk of death than women and those with ECOG PS 0-1 in the intermediate/high risk group for KRS.The higher the score,the higher the risk of early death;however,the relevance of this independent prediction decreased with longer survival.The overall survival of each patient was recorded via real-world follow-up and retrospective observations,and this study yielded the overall relationship between KRS and all-cause mortality.CONCLUSION The prechemotherapy baseline of KRS was independently associated with all-cause mortality within 2 years;however,this independent predictive relationship weakened as survival time increased.

Influence of Underlying Diseases and Age on the Association between Obesity and All-Cause Mortality in Post-Middle Age

Background: Studies on the association between obesity and all-cause mortality have found that the degree of obesity is directly proportional to all-cause mortality. In contrast, there have been studies indicating that obese people with underlying diseases have a higher survival rate. We hypothesized that age and underlying diseases lead to such contrasting results. Therefore, we conducted a study to clarify the influence of post-middle age obesity and underlying diseases on all-cause mortality. Methods: This study used data from longitudinal studies in the United States, which conducted follow-up for 19 years on 33,708 participants in different age groups: ≥45, 45 - 64, and ≥65 years. Hazard ratio (HR) was determined using the Cox proportional hazards model to analyze a group consisting of all participants, a group of those with underlying diseases, and a group of those without underlying diseases, considering age, gender, education history, marital status, household income, smoking history, and BMI category as covariates. Results: In the group aged ≥65 without underlying diseases, HR was almost 1 in those with BMI 25 - 35 kg/m2. Further, HR was higher in the 45 - 64 age group without underlying diseases if BMI was >35 kg/m2. However, HR was approximately 1 in the ≥65 age group. Conclusions: The study revealed that among individuals aged ≥65 years without underlying diseases, there was no association between obesity and all-cause mortality. Among individuals without underlying diseases, HR was higher in the 45 - 64 age group with BMI > 35 kg/m2 but was approximately 1 among those aged ≥65 years. Therefore, an interaction based on age was detected. These findings may lead to recommendations regarding the need to modify the advice and education provided to obese individuals in different age groups.

Vitamin d deficiency and metabolic syndrome:The joint effect on cardiovascular and all-cause mortality in the United States adults

BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.

Dietary oleic acid intake,olive oil consumption,and risk of cardiovascular and all-cause mortality

Objective:Oleic acid,a subtype of monounsaturated fatty acid(MUFA),is present in abundance in certain edible oils,particularly olive oils.Epidemiological evidence concerning dietary oleic acid intake and the long-term risk of mortality is lacking.This study aimed to evaluate the associations of the dietary intake of oleic acid and other specific subtypes of MUFAs,olive oil,and other vegetable oils with cardiovascular disease(CVD)and all-cause mortality.Methods:This prospective cohort study included adults aged 40 years or older who participated in the included U.S.adults National Health and Nutrition Examination Survey(NHANES).Dietary MUFA intake was assessed via 24-h dietary recall interviews in NHANES 1999–2018,and the consumption of olive oil and other vegetable oils was assessed via a food frequency questionnaire in NHANES 2003–2006.Deaths and underlying causes of death were ascertained by linkage to the National Death Index through December 31,2019.Weighted Cox proportional hazards regression models were used to estimate the hazard ratio(HR)and 95%CIs.Results:Dietary intake of total MUFAs and oleic acid was associated with a lower risk of CVD mortality,with HRs(95%CI)of 0.62(0.39–0.99)and 0.61(0.39–0.97),respectively.Total MUFA and oleic acid intake were inversely associated with all-cause mortality;the multivariable-adjusted HRs were 0.77(95%CI:0.60–0.99)and 0.78(95%CI:0.62–0.99),respectively.There was no significant association between palmitoleic acid intake and all-cause mortality.The habitual consumption of olive oil,but not the consumption of other vegetable oils,was inversely associated with the risk of cardiovascular mortality.In the joint association analysis,the HRs(95%CI)of cardiovascular mortality were 0.36(0.19–0.69)for people who exclusively consumed olive oil,0.59(0.27–1.32)for people who consumed both olive oil and other vegetable oils,and 0.73(0.46–1.14)for people who exclusively consumed other vegetable oils compared with people who never consumed vegetable oils.Conclusions:In a U.S.nationally representative prospective cohort,higher dietary oleic acid intake and olive oil consumption were associated with a lower risk of cardiovascular mortality.

The association of serum manganese concentrations with all-cause,cardiovascular disease and cancer mortality:A cohort study based on the 2011–2014 National Health and Nutrition Examination Survey(NHANES)

Objectives:There is a debate on the association between the circulating manganese(Mn)levels and mortality.The aim of this study was to explore the nonlinear association between the serum Mn levels and all-cause or cause-specific mortality.Methods:We included 8,145 adults from the United States(US)and their serum Mn concentrations obtained from the National Health and Nutrition Examination Survey(NHANES 2011–2014).We retrieved their survival information from baseline until 2019 using the national death index.Multivariable Cox proportional hazards models were used to show the risk of all-cause or cause-specific mortality according to the baseline serum Mn concentrations.Smooth curve fitting and threshold effect analyses were used to clarify the potential nonlinearity.Results:During a median follow-up of 6.2 years,there were 716 deaths from all causes,224 of which were due to cardiovascular dis-ease(CVD)and 165 due to cancer.The serum Mn levels exhibited a U-shaped relationship with all-cause or CVD-associated mortality.Serum Mn levels lower than the threshold value(7.32μg/L)were negatively associated with all-cause(fully adjusted HR:0.86,95%CI:0.80–0.94)and CVD(fully adjusted HR:0.82,95%CI:0.71–0.94)mortality.In contrast,serum Mn levels higher than the threshold value(7.32μg/L)were positively associated with all-cause(fully adjusted HR:1.04,95%CI:1.02–1.06)and CVD(fully adjusted HR:1.05,95%CI:1.02–1.08)mortality.Conclusions:The serum Mn concentrations showed a U-shaped relationship with all-cause and CVD-associated mortality among NHANES participants.

Weight change and all-cause and cause-specific mortality:A 25-year follow-up study

Background:Whether the dynamic weight change is an independent risk factor for mortality remains controversial.This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial(NIT)cohort.Methods:Body weight of 21,028 healthy residents of Linxian,Henan province,aged 40-69 years was measured two times from 1986 to 1991.Outcome events were prospectively collected up to 2016.Weight maintenance group(weight change<2 kg)or stable normal weight group was treated as the reference.Cox proportional hazard model was performed to calculate hazard ratios(HRs)and 95%confidence intervals(95%CIs)to estimate the risk of mortality.Results:A total of 21,028 subjects were included in the final analysis.Compared with the weight maintenance group,subjects with weight loss≥2 kg had an increased risk of death from all-cause(HR_(All-cause)=1.14,95%CI:1.09-1.19,P<0.001),cancer(HR_(Cancer)=1.12,95%CI:1.03-1.21,P=0.009),and heart disease(HR_(Heart diseases)=1.21,95%CI:1.11-1.31,P<0.001),whereas subjects with weight gain≥5 kg had 11%(HR_(Cancer)=0.89,95%CI:0.79-0.99,P=0.033)lower risk of cancer mortality and 23%higher risk of stroke mortality(HR_(Stroke)=1.23,95%CI:1.12-1.34,P<0.001).For the change of weight status,both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death(HR_(Overweight to normal)=1.18,95%CI:1.09-1.27;HR_(Becoming underweight)=1.35,95%CI:1.25-1.46)and cancer death(HR_(Overweight to normal)=1.20,95%CI:1.04-1.39;HR_(Becoming underweight)=1.44,95%CI:1.24-1.67),while stable overweight could increase the risk of total death(HR_(Stable overweight)=1.11,95%CI:1.05-1.17)and death from stroke(HR_(Stable overweight)=1.44,95%CI:1.33-1.56).Interaction effects were observed between age and weight change on cancer mortality,as well as between baseline BMI and weight change on all-cause,heart disease,and stroke mortality(all P_(interaction)<0.01).Conclusions:Weight loss was associated with an increased risk of all-cause,cancer,and heart disease mortality,whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality.Efforts of weight management should be taken to improve health status.Trial registration:https://classic.clinicaltrials.gov/,NCT00342654.