The Association of Mercury and ALT with Obesity in Korean Adults Using Data from the Korea National Health and Nutrition Examination Survey for 11 Years(KNHANES 2005,2008-2017)

The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.

Low skeletal muscle mass is associated with non-alcoholic fatty liver disease in Korean adults： the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND： Sarcopenia and non-alcoholic fatty liver dis- ease （NAFLD） share similar pathophysiological mechanisms, and the relationship between sarcopenia and NAFLD has been recently investigated. The study investigated whether low skel- etal muscle mass is differentially associated with NAFLD by gender in Korean adults. METHODS： We conducted a cross-sectional analysis of the data from the Fifth Korea National Health and Nutrition Examination Survey. The skeletal muscle index （SMI） was obtained by the appendicular skeletal muscle mass divided by the weight. NAFLD was defined as a fatty liver index （FLI） 〉60 in the absence of other chronic liver disease. RESULTS： Among the included subjects, 18.3% （SE： 1.4%） in men and 7.0% （SE： 0.7%） in women were classified as having FLI-defined NAFLD. Most of the risk factors for FLI-defined NAFLD showed a significant negative correlation with the SMI in both genders. Multiple logistic regression analysis showed that low SMI was associated with FLI-defined NAFLD, inde- pendent of other metabolic and lifestyle parameters in both genders [males： odds ratio （OR）=1.35; 95% confidence inter- val （CI）： 1.17-1.54; females： OR=1.36; 95% CI： 1.18-1.55]. The magnitude of the association between FLI-defined NAFLD and low SMI was higher in middle aged to elderly males （OR-1.50; 95% CI： 1.22-1.84） than in males less than 45 years of age （OR=1.25; 95% CI： 1.02-1.52） and in premenopausal females （OR=l.50; 95% CI： 1.12-2.03） than in postmenopausal females （OR-1.36; 95% CI： 1.20-1.54）.CONCLUSIONS： Low SMI is associated with the risk of FLI- defined NAFLD independent of other well-known metabolic risk factors in both genders. This association may differ ac- cording to age group or menopausal status. Further studies are warranted to confirm this relationship.

Associations between remnant cholesterol levels and mortality in patients with diabetes

BACKGROUND Dyslipidemia is frequently present in patients with diabetes.The associations of remnant cholesterol and mortality remains unclear in patients with diabetes.AIM To explore the associations of remnant cholesterol with all-cause and cardiovas-cular mortality in patients with diabetes.METHODS This prospective cohort study included 4740 patients with diabetes who par-ticipated in the National Health and Nutrition Examination Survey from 1999 through 2018.Remnant cholesterol was used as the exposure variable,and all-cause and cardiovascular mortality were considered outcome events.Outcome data were obtained from the National Death Index,and all participants were followed from the interview date until death or December 31,2019.Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes,in which remnant cholesterol was modeled as both a categorical and a continuous variable.Restricted cubic splines(RCSs)were calculated to assess the nonlinearity of associations.Subgroup(stratified by sex,age,body mass index,and duration of diabetes)and a series of sensitivity analyses were performed to evaluate the robustness of the associations.RESULTS During a median follow-up duration of 83 months,1370 all-cause deaths and 389 cardiovascular deaths were documented.Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality[hazard ratio(HR)95%confidence interval(CI):0.66(0.52-0.85)];however,when remnant cholesterol was modeled as a continuous variable,it was associated with increased risks of all-cause[HR(95%CI):1.12(1.02-1.21)per SD]and cardiovascular[HR(95%CI):1.16(1.01-1.32),per SD]mortality.The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality.Subgroup and sensitivity analyses did not reveal significant differences from the above results.CONCLUSION In patients with diabetes,higher remnant cholesterol was associated with increased risks of all-cause and cardiovascular mortality,and diabetes patients with slightly higher remnant cholesterol(0.68-1.04 mmol/L)had a lower risk of all-cause mortality.

Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

Association of total bilirubin with depression risk in adults with diabetes:A cross-sectional study

BACKGROUND Individuals with diabetes mellitus are more likely to experience depression,although most patients remain undiagnosed.The relation between total bilirubin and depression has been increasingly discussed,but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes,which warrants attention.AIM To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes.METHODS The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018.Depression was determined using the Patient Health Questionnaire-9.Multivariable logistic regression,propensity scorematched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes.RESULTS The study included 4758 adults with diabetes,of whom 602(12.7%)were diagnosed with depression.After adjusting for covariates,we found that diabetic adults with lower total bilirubin levels had a higher risk of depression(OR=1.230,95%CI:1.006-1.503,P=0.043).This association was further confirmed after propensity score matching(OR=1.303,95%CI:1.034-1.641,P=0.025).Subgroup analyses showed no significant dependence of age,body mass index,sex,race or hypertension on this association.Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels.The depression risk heightened with the increasing levels of total bilirubin,reaching the highest risk at 6.81μmol/L and decreasing thereafter.CONCLUSION In adults with diabetes,those with lower levels of total bilirubin were more likely to have depressive symptoms.Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.

Dietary fiber intake and its association with diabetic kidney disease in American adults with diabetes:A cross-sectional study

BACKGROUND Dietary fiber(DF)intake may have a protective effect against type 2 diabetes(T2D);however,its relationship with diabetic kidney disease(DKD)remains unclear.AIM To investigate the potential association between DF intake and the prevalence of DKD in individuals diagnosed with T2D.METHODS This cross-sectional study used data from the National Health and Nutrition Examination Survey collected between 2005 and 2018.DF intake was assessed through 24-h dietary recall interviews,and DKD diagnosis in individuals with T2D was based on predefined criteria,including albuminuria,impaired glomerular filtration rate,or a combination of both.Logistic regression analysis was used to assess the association between DF intake and DKD,and comprehensive subgroup and sensitivity analyses were performed.RESULTS Among the 6032 participants,38.4%had DKD.With lower DF intake-T1(≤6.4 g/1000 kcal/day)-as a reference,the adjusted odds ratio for DF and DKD for levels T2(6.5-10.0 g/1000 kcal/day)and T3(≥10.1 g/1000 kcal/day)were 0.97(95%CI:0.84-1.12,P=0.674)and 0.79(95%CI:0.68-0.92,P=0.002),respectively.The subgroup analysis yielded consistent results across various demographic and health-related subgroups,with no statistically significant interactions(all P>0.05).CONCLUSION In United States adults with T2D,increased DF intake may be related to reduced DKD incidence.Further research is required to confirm these findings.

Association between serum estradiol level and appendicular lean mass index in middle-aged postmenopausal women

BACKGROUND Previous studies investigating the association between loss of estrogen at menopause and skeletal muscle mass came to contradictory conclusions.AIM To evaluate the association between serum estradiol level and appendicular lean mass index in middle-aged postmenopausal women using population-based data.METHODS This study included 673 postmenopausal women,aged 40-59 years,from the National Health and Nutrition Examination Survey between 2013 and 2016.Weighted multivariable linear regression models were used to evaluate the association between serum E2 Level and appendicular lean mass index(ALMI).When non-linear associations were found by using weighted generalized additive model and smooth curve fitting,two-piecewise linear regression models were further applied to examine the threshold effects.RESULTS There was a positive association between serum E2 level and ALMI.Compared to individuals in quartile 1 group,those in other quartiles had higher ALMI levels.An inverted U-shaped curve relationship between serum E2 Level and ALMI was found on performing weighted generalized additive model and smooth curve fitting,and the inflection point was identified as a serum E2 level of 85 pg/mL.CONCLUSION Our results demonstrated an inverted U-shaped curve relationship between serum E2 levels and ALMI in middle-aged postmenopausal women,suggesting that low serum E2 levels play an important in the loss of muscle mass in middleaged postmenopausal women.

Association of low muscle strength with metabolic dysfunctionassociated fatty liver disease:A nationwide study

BACKGROUND There is limited evidence regarding the association between muscle strength and metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the association between muscle strength and MAFLD in the general population in Korea.METHODS This nationwide representative cross-sectional study included 31649 individuals aged≥19 years who participated in the Korea National Health and Nutrition Examination Survey between 2015 and 2018.Odds ratios(ORs)and 95%confidence intervals(95%CIs)for MAFLD according to sex-specific quartiles of muscle strength,defined by relative handgrip strength,were calculated using multivariable logistic regression analysis.Additionally,multivariable logistic regression analysis was used to assess the association between muscle strength and probable liver fibrosis in patients with MAFLD.RESULTS Of all the participants,29.3%had MAFLD.The prevalence of MAFLD was significantly higher in the lower muscle strength quartile groups for all participants,sexes,and age groups(P<0.001).A 1.92-fold(OR=1.92,95%CI:1.70–2.16)and 3.12-fold(OR=3.12,95%CI:2.64–3.69)higher risk of MAFLD was observed in the lowest quartile(Q1)group than in the other groups(Q2–Q4)and the highest quartile(Q4)group,respectively.The ORs of MAFLD were significantly increased in the lower muscle strength quartile groups in a dose-dependent manner(P for trend<0.001).These associations persisted in both sexes.An inverse association between muscle strength and the risk of MAFLD was observed in all subgroups according to age,obesity,and diabetes mellitus.In patients with MAFLD,the odds of severe liver fibrosis were higher in Q1(OR=1.83,95%CI:1.25–2.69)than in other groups(Q2–Q4).CONCLUSION Among Korean adults,low muscle strength was associated with an increased risk of MAFLD and liver fibrosis in patients with MAFLD.

Data mining in clinical big data:the frequently used databases,steps,and methodological models

Many high quality studies have emerged from public databases,such as Surveillance,Epidemiology,and End Results(SEER),National Health and Nutrition Examination Survey(NHANES),The Cancer Genome Atlas(TCGA),and Medical Information Mart for Intensive Care(MIMIC);however,these data are often characterized by a high degree of dimensional heterogeneity,timeliness,scarcity,irregularity,and other characteristics,resulting in the value of these data not being fully utilized.Data-mining technology has been a frontier field in medical research,as it demonstrates excellent performance in evaluating patient risks and assisting clinical decision-making in building disease-prediction models.Therefore,data mining has unique advantages in clinical big-data research,especially in large-scale medical public databases.This article introduced the main medical public database and described the steps,tasks,and models of data mining in simple language.Additionally,we described data-mining methods along with their practical applications.The goal of this work was to aid clinical researchers in gaining a clear and intuitive understanding of the application of data-mining technology on clinical big-data in order to promote the production of research results that are beneficial to doctors and patients.

Elevated Arsenic Exposure Is Associated with an Increased Risk of Chronic Hepatitis B Virus Infection： NHANES （2003-2014） in U.S. Adults

Studies concerning the association between arsenic exposure and hepatitis B virus （HBV） infection have been lacking. The present study aimed to examine the association between total urinary arsenic （TUA） and infection ofHBV. A total of 5186 participants from National Health and Nutrition Examination Survey （NHANES） 2003-2014 were included in the analysis. We used logistic regression to evaluate the association. We defined two measures of TUA. TUA1 was the sum of arsenous acid, arsenicacid, monomethylarsonic acid and dimethylarsenic acid. TUA2 was defined as TUA minus arsenobetaine and arsenocholine. The results showed that the weighted overall prevalence of HBV infection was 6.08%. For NHANES 2003-2014, the medians （interquartile range） of TUA1 and TUA2 were 5.60 μg/L （3.97-8.09 μg/L） and 4.91 μg/L （2.36-9.11 μg/L）, respectively. Comparing the highest quartile to the lowest quartile after multivariable adjustment showed that the odds ratios （ORs） and 95% confidence intervals （CIs） for TUA1 and TUA2 were 2.44 （1.40-4.27） and 2.84 （1.60-5.05）, respectively. In conclusion, elevated urinary arsenic was associated with the risk of HBV infection. Further studies, especially prospective studies, are needed to confirm the causal relationship between arsenic exposure and HBV infection.

Relationship between alcohol intake and dietary pattern:Findings from NHANES Ⅲ

AIM:To examine the association between macronutrient dietary patterns and alcohol consumption using the Third National Health and Nutritional Examination Survey METHODS:A total of 9877 subjects(5144 males) constituted the study cohort.Dietary interviews were conducted with all examinees by a trained dietary interviewer in a mobile examination center(MEC).Subjects reported all foods and beverages consumed except plain drinking water for the previous 24-h time period.Physical examination and history of alcohol consumption were obtained.Pearson correlation coefficients were used to evaluate the association of the levels of alcohol consumption and the percentage of energy derived from macronutrients.Univariate and multivariate regression analyses were performed accounting for the study sampling weight to further explore the relationships between alcohol consumption and calories derived from each macronutrient.RESULTS:Subjects who drank were younger than nondrinker controls in both genders(P < 0.01).Alcohol intake was inversely associated with body mass index and body weight in women.Of all macronutrients,carbohydrate intake was the first to decrease with increasing alcohol consumption.In the multivariate analyses,the level of alcohol consumption was found to be an independent predictor associated with lower intake of other macronutrients.CONCLUSION:Our results show that there is an alteration in the daily dietary pattern with increasing alcohol consumption and that energy derived from alcoholic beverages substitutes that from other macronutrients such as carbohydrate,protein,and fat.

Prevalence and risk factors of steatosis and advanced fibrosis using transient elastography in the United States’ adolescent population

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease in children and adolescents.AIM To determine the prevalence and risk factors of steatosis and advanced fibrosis using transient elastography(TE)in the United States’adolescent population.METHODS Using the National Health and Nutrition Examination Survey 2017-2018,adolescent participants aged 13 to 17 years who underwent TE and controlled attenuation parameter(CAP)were included in this study.Forty-one factors associated with liver steatosis and fibrosis were collected.Univariate and multivariate linear regression analysis were used to identify statistically significant predictors.RESULTS Seven hundred and forty participants met inclusion criteria.Steatosis(S1-S3),based on CAP,and advanced fibrosis(F3-F4),based on TE,were present in 27%and 2.84%of the study population,respectively.Independent predictors of steatosis grade included log of alanine aminotransferase,insulin resistance,waistto-height ratio,and body mass index.Independent predictors of fibrosis grade included steatosis grade,non-Hispanic black race,smoking history,and systolic blood pressure.CONCLUSION This study demonstrated a high prevalence of steatosis in the United States’adolescent population.Almost 3%of United States’adolescents had advanced fibrosis.These findings are concerning because a younger age of onset of NAFLD can lead to an earlier development of severe disease,including steatohepatitis,cirrhosis,and liver decompensation.

Hemoglobin within normal range is negatively related to hemoglobin A1c in a nondiabetic American population aged 16 years and older

BACKGROUND Protein glycosylated hemoglobin,hemoglobin A1c(HbA1c)binds hemoglobin(Hb)in red blood cells to blood glucose.However,the relationship between Hb and HbA1c remains unclear.AIM To elucidate their relationship in a nondiabetic population aged≥16 years in the United States,using data from the 1999-2018 National Health and Nutrition Examination Survey.METHODS This study was based on data from 44560 adults aged≥16 years,excluding those with diabetes.The relationship was estimated using a multivariate regression.We also used piecewise linear regression for subgroup analysis based on age and sex stratification and analysis of the threshold effects of Hb on HbA1c.RESULTS Hb and HbA1c levels were negatively correlated in the unadjusted model(β=-0.01;95%CI:-0.01,-0.01).The correlation was significantly negative when the regression model was minimally regulated and stratified by age and sex,and remained negative when the model was further regulated(more than 10%)to identify covariates with the HbA1c level influence estimates.In subgroup analyses based on age and sex stratification,the association remained negative when the covariates were controlled.A nonlinear relationship was observed between them when the Hb levels reached the tipping point(13.2 g/dL)(adjusted odds ratio,-0.04;95%CI:-0.05,-0.03)and when the Hb levels exceeded 13.2 g/dL(adjusted odds ratio,-0.10;95%CI:-0.10,-0.09).CONCLUSION Our study shows that normal Hb levels are negatively correlated with HbA1c in nondiabetic Americans aged≥16 years.

Association between urinary concentrations of bisphenol A substitutes and diabetes in adults

BACKGROUND Due to new restrictions on the use of bisphenol A(BPA),industries are beginning to replace it with derived molecules such as bisphenol S and F(BPS and BPF).There is extensive evidence in the academic literature on the potential health effects of BPA,which is known to be a diabetogenic molecule.However,there are few publications related to new compounds derived from BPA.AIM To perform an epidemiological study of urinary BPS and BPF in the American National Health and Nutrition Examination Survey(NHANES)cohort,and analyze their possible relationship with diabetes mellitus.METHODS NHANES datasets from 2013 to 2016 were used due to the urinary BPF and BPS availability.Data from 3658 adults were analyzed to perform regression analysis exploring the possible relationship between BPA-derived compounds and diabetes.RESULTS Descriptive statistics,linear regression modeling,and logistic regression analysis revealed a significant relationship between urinary BPS,but not BPF,and diabetes risk.Additionally,a relationship was observed between both compounds and hypertension and a slight relationship between BPF and dyslipidemia.CONCLUSION In the present study,a strong relationship between urinary BPS,not BPF,and diabetes risk has been determined.BPA substitute molecules do not exempt the population from potential health risks.

Hypertension and NAFLD risk:Insights from the NHANES 2017-2018 and Mendelian randomization analyses

Background:Hypertension and non-alcoholic fatty liver disease(NAFLD)share several pathophysiologic risk factors,and the exact relationship between the two remains unclear.Our study aims to provide evidence concerning the relationship between hypertension and NAFLD by analyzing data from the National Health and Nutrition Examination Survey(NHANES)2017-2018 and Mendelian randomization(MR)analyses.Methods:Weighted multivariable-adjusted logistic regression was applied to assess the relationship between hypertension and NAFLD risk by using data from the NHANES 2017-2018.Subsequently,a two-sample MR study was performed using the genome-wide association study(GWAS)summary statistics to identify the causal association between hypertension,systolic blood pressure(SBP),diastolic blood pressure(DBP),and NAFLD.The primary inverse variance weighted(IVW)and other supplementary MR approaches were conducted to verify the causal association between hypertension and NAFLD.Sensitivity analyses were adopted to confirm the robustness of the results.Results:A total of 3144 participants were enrolled for our observational study in NHANES.Weighted multivariable-adjusted logistic regression analysis suggested that hypertension was positively related to NAFLD risk(odds ratio[OR]=1.677;95%confidence interval[CI],1.159-2.423).SBP≥130 mmHg and DBP≥80 mmHg were also significantly positively correlated with NAFLD.Moreover,hypertension was independently connected with liver steatosis(β=7.836[95%CI,2.334-13.338]).The results of MR analysis also supported a causal association between hypertension(OR=7.203[95%CI,2.297-22.587])and NAFLD.Similar results were observed for the causal exploration between SBP(OR=1.024[95%CI,1.003-1.046]),DBP(OR=1.047[95%CI,1.005-1.090]),and NAFLD.The sensitive analysis further confirmed the robustness and reliability of these findings(all P>0.05).Conclusion:Hypertension was associated with an increased risk of NAFLD.

Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents

Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied.This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.Methods Seven thousand,five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8–18 years from the 2013–2015 China Child and Adolescent Cardiovascular Health study and the 2011–2018 National Health and Nutrition Examination Surveys were analyzed.Blood pressure and body composition(fat and muscle)were measured by trained staff.The crude prevalence and age-standardized prevalence rate(ASPR)of primary HTN and its subtypes[isolated systolic hypertension(ISH)and isolated diastolic hypertension(IDH)]were calculated based on 2017 American Academy of Pediatrics guidelines.Multivariable-adjusted linear regression coefficients and odds ratios(ORs)were calculated to assess the associations of body composition indicators with HTN,ISH and IDH.Results The ASPR of HTN was 18.5%in China(CN)and 4.6%in the United States(US),whereas the obesity prevalence was 7.4%and 18.6%,and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN.Increased fat mass,muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries.The percent of muscle body mass had a protective effect on HTN and ISH in both countries[HTN(CN:OR=0.83,95%CI=0.78–0.88;US:OR=0.72,95%CI=0.64–0.81);ISH(CN:OR=0.87,95%CI=0.80–0.94;US:OR=0.71,95%CI=0.62–0.81)],and the protective effect was more common among children and adolescents with high levels of physical activity.Conclusions The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US,and the contribution of obesity to HTN was higher in the US than in CN.Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations.Optimizing body composition positively influences blood pressure in children and adolescents,particularly those with high-level physical activity.

Environmental exposure to perchlorate,nitrate,and thiocyanate in relation to chronic kidney disease in the general US population,NHANES 2005-2016

Background:Few studies have explored the impact of perchlorate,nitrate,and thiocyanate(PNT)on kidney function.This study aimed to evaluate the association of urinary levels of PNT with renal function as well as the prevalence of chronic kidney disease(CKD)among the general population in the United States.Methods:This analysis included data from 13,373 adults(≥20 years)from the National Health and Nutrition Examination Survey 2005 to 2016.We used multivariable linear and logistic regression,to explore the associations of urinary PNT with kidney function.Restricted cubic splines were used to assess the potentially non-linear relationships between PNT exposure and outcomes.Results:After traditional creatinine adjustment,perchlorate(P-traditional)was positively associated with estimated glomerular filtration rate(eGFR)(adjustedβ:2.75;95%confidence interval[CI]:2.25 to 3.26;P<0.001),and negatively associated with urinary albumin-to-creatinine ratio(ACR)(adjustedβ:-0.05;95%CI:-0.07 to-0.02;P=0.001)in adjusted models.After both traditional and covariate-adjusted creatinine adjustment,urinary nitrate and thiocyanate were positively associated with eGFR(all P values<0.05),and negatively associated with ACR(all P values<0.05);higher nitrate or thiocyanate was associated with a lower risk of CKD(all P values<0.001).Moreover,there were L-shaped non-linear associations between nitrate,thiocyanate,and outcomes.In the adjusted models,for quartiles of PNT,statistically significant dose-response associations were observed in most relationships.Most results were consistent in the stratified and sensitivity analyses.Conclusions:Exposures to PNT might be associated with kidney function,indicating a potential beneficial effect of environmental PNT exposure(especially nitrate and thiocyanate)on the human kidney.

The association between heavy metal exposure and erectile dysfunction in the United States

Literature regarding the impacts of heavy metal exposure on erectile dysfunction(ED)is scarce.We aimed to evaluate the correlation between 10 urinary metals and ED in a large,nationally representative adult male sample.The dataset was extracted from the National Health and Nutrition Examination Survey(NHANES)during the period of 2001–2002 and 2003–2004.Weighted proportions and multivariable logistic regression analysis adjusted for confounding variables were utilized to determine the relationship between metal exposure and ED.Weighted quantile sum(WQS)regression was utilized to evaluate the impact of a mixture of urinary metals on ED.A total of 1328 participants were included in our study.In multivariable logistic regression analysis,cobalt(Co)and antimony(Sb)were positively associated with ED(odds ratio[OR]:1.36,95%confidence interval[CI]:1.10–1.73,P=0.020;and OR:1.41,95%CI:1.12–1.77,P=0.018,respectively)after full adjustment.Men in tertile 4 for Co(OR:1.49,95%CI:1.02–2.41,P for trend=0.012)and Sb(OR:1.53,95%CI:1.08–2.40,P for trend=0.041)had significantly higher odds of ED than those in tertile 1.Furthermore,the WQS index was significantly linked with increased odds of ED after full adjustment(OR:1.31,95%CI:1.04–1.72,P<0.05).Our study expanded on previous literature indicating the possible role of heavy metal exposure in the etiology of ED.The evaluation of heavy metal exposure should be included in the risk assessment of ED.