BMI mediates the association of serum uric acid with bone health: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES).

BACKGROUND: The associations between serum uric acid and osteoporosis or osteopenia remain controversial, and few studies have explored whether BMI acts as a mediators in the association between the SUA and OP/ osteopenia. OBJECTIVE: To explore the relationship between serum uric acid and osteoporosis or osteopenia among US adults. METHODS: A cross-sectional study was conducted to examine the association between serum uric acid and osteoporosis or osteopenia from four cycles of NHANES. Binary logistic regression models and restricted cubic spline models were used to evaluate the association between serum uric acid and osteoporosis or osteopenia, and interaction analysis was used to test the differences between subgroups. Mediation analysis was utilized to investigate whether BMI acts as a mediator in the association between SUA and OP/ osteopenia. RESULTS: 12581 participants aged ≥ 18 years were included. A U-shape nonlinear relationship between SUA and osteoporosis or osteopenia in all people was found (P < 0.0001, P for nonlinear = 0.0287). There were significant interactions in age subgroups (P for interaction = 0.044), sex subgroups (P for interaction = 0.005), and BMI subgroups (P for interaction = 0.017). We further assessed the subgroups and found the optimal range of serum uric acid levels with a lower risk of osteoporosis or osteopenia was 357-535 µmol/L in males, 327-417 µmol/L in people aged ≥ 50 years, above 309 µmol/L in people aged < 50 years, 344-445 µmol/L in people with BMI ≥ 30, and above 308 µmol/L in people with BMI < 30. BMI fully mediated the association of SUA and OP/osteopenia, with a value of -0.0024(-0.0026--0.0021). These results were robust in sensitivity analyses. CONCLUSIONS: A complicated relationship between SUA and bone health in different populations was observed. Maintaining SUA within a specific range may be beneficial to bone health. In addition, BMI may play an important role in the association between SUA and bone health, but considering the limitations of this study, further prospective research is required.

Establishment and evaluation of a novel practical tool for the diagnosis of pre-sarcopenia in young people with diabetes mellitus.

OBJECTIVE: Sarcopenia has been recognized as a third category of complications in people with diabetes. However, few studies focus on the reduction of skeletal muscle mass in young people with diabetes. The aim of this study was to investigate risk factors of pre-sarcopenia in young patients with diabetes and establish a practical tool to diagnose pre-sarcopenia in those people. METHODS: Patients (n = 1246) enrolled from the National Health and Nutrition Examination Survey (NHANES) cycle year of 2011 to 2018 were randomly divided into the training set and validation set. The all-subsets regression analysis was used to select the risk factors of pre-sarcopenia. A nomogram model for the prediction of pre-sarcopenia in the diabetic population was established based on the risk factors. The model was evaluated by the area under the receiver operating characteristic curve for discrimination, calibration curves for calibration, and decision curve analysis curves for clinical utility. RESULTS: In this study, gender, height, and waist circumference were elected as predictive factors for pre-sarcopenia. The nomogram model presented excellent discrimination in training and validation sets with areas under the curve of 0.907 and 0.912, respectively. The calibration curve illustrated excellent calibration, and the decision curve analysis showed a wide range of good clinical utility. CONCLUSIONS: This study develops a novel nomogram that integrates gender, height, and waist circumference and can be used to easily predict pre-sarcopenia in diabetics. The novel screen tool is accurate, specific, and low-cost, highlighting its potential value in clinical application.

Effects of different corticosteroid therapy on severe COVID-19 patients: a meta-analysis of randomized controlled trials.

BACKGROUND: To assess the efficacy and safety of corticosteroids in COVID-19 patients compared with standard care or placebo. METHODS: Electronic databases were searched to identify relevant studies. The mortality, adverse events, and other data from studies were pooled for statistical analysis. RESULTS: Ten randomized clinical trials were eligible for inclusion. Corticosteroid treatment in COVID-19 patients did not significantly reduce the risk of death (RR: 0.93; CI: 0.82, 1.05) and the need for mechanical ventilation (RR: 0.82; CI: 0.62, 1.08). No mortality reduction was also observed in the subgroup of patients requiring mechanical ventilation (RR: 0.90; CI: 0.79-1.03). The use of corticosteroids increased mortality in the subgroup of patients not requiring oxygen support (RR: 1.24; CI: 1.00-1.55). The survival benefit was observed in a low dosage of corticosteroids (RR: 0.90; CI: 0.84-0.97) and dexamethasone (RR: 0.90; 95% CI: 0.79-1.04). There was no difference in the rates of adverse events (RR: 1.13; CI: 0.58, 2.20) and secondary infections (RR: 0.87; CI: 0.66, 1.15). CONCLUSION: Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. Low-dose dexamethasone could be considered as a drug for the treatment of COVID-19 patients. More high-quality trials are needed to further verify this conclusion.Expert Opinion: The effect of corticosteroids on patient survival highly depended on the selection of the right dosage and type and in a specific subgroup of patients. This meta-analysis, which included more RCTs, evaluated the safety and efficacy in severe COVID-19 patients and analyzed the effects of different types of corticosteroid treatments. Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. But the low dose dexamethasone appear to have a role in the management of severe COVID-19 patients.

Associations of serum carotenoids with the severity of sunburn and the risk of cancer: A cross-sectional analysis of 1999-2018 NHANES data.

Background: Sunburn is a common problem for outdoor workers and casual outdoor walkers. Carotenoids are important elements in normal function of skin tissue and skin metabolism and are critical in the development of some cancers. However, the possible relationships between sunburn sensitivity, carotenoids and the risk of cancers remain unknown. Objectives: To explore the associations of serum carotenoids with sunburn severity and the risk of cancers. Methods: A cross-sectional study from the National Health and Nutrition Examination Survey from 1999 to 2018 were conducted. The relationship between sunburn and serum carotenoids, cancers were investigated by unconditional or ordinal logistic regression. Mediation analysis was used to explore the effect of carotenoids on the relationship between sunburn and cancers. Results: A total of 25,440 US adults from 1999 to 2018 were enrolled in this study. There were significant differences in sex, race and natural hair color between the sunburn and non-sunburn people. The severity of sunburn was significantly associated with serum trans-ß-carotene, cis-ß-carotene, combined lutein, and vitamin A. The odds ratios of severe reactions were 5.065 (95% CI: 2.266-11.318) in melanoma patients, 5.776 (95% CI: 3.362-9.922) in non-melanoma patients, and 1.880 (95% CI: 1.484-2.380) in non-skin cancers patients. Additionally, serum carotenoids were partially attributable to the effect of sunburn on skin and non-skin cancers. Conclusion: Sunburn severity was associated with cancers, and severer sunburn was related with higher risk of cancers. Serum carotenoids were also associated with sunburn severity. Moreover, the relationship between sunburn and cancers was mediated by some serum carotenoids.