Association between human papillomaviruses, metabolic syndrome, and all-cause death; analysis of the U.S. NHANES 2003-2004 to 2015-2016.

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection, attributed to 4.5% of all cancers worldwide. Co-infection with the metabolic syndrome (MetS), a common cluster of cardiometabolic risk factors, has been shown to increase the persistence of HPV. The purpose of this study was to estimate the association between HPV and MetS on mortality risk. METHODS: Data for the current study was drawn from seven consecutive cycles (2003-2004 to 2015-2016) of the U.S. NHANES. The final analytic sample consisted of 5,101 individuals aged 18-65y with HPV and MetS information with follow-up to Dec. 31st, 2019. Baseline HPV status was assessed by either vaginal swab, penile swab or oral rinse and used to classify participants as: no HPV (n = 1,619), low (n = 1,138), probable (n = 672), and high-risk (n = 1,672; 22% type 16, and 10% type 18) HPV using IARC criteria. MetS was assessed by the Harmonized criteria. RESULTS: The average follow-up was 9.4 y with 240 all-cause deaths (no HPV: n = 46 deaths; low-risk: n = 60 deaths; probable: n = 37 deaths, and; high-risk: n = 97 deaths). HPV status alone revealed no associations with mortality in fully adjusted models. Cross-classification into discrete MetS/HPV strata yielded an increased risk of mortality in females with high-risk HPV/MetS relative to the no MetS/no HPV group. CONCLUSIONS: In this study, low, probable, and high-risk HPV and MetS were differentially related to mortality risk in men and women. Further work is necessary to separate the temporal, age, vaccination, and sex effects of HPV diagnosis in these relationships using prospective studies with detailed histories of HPV infection and persistence.

A systematic review and meta-analysis of the effect of treadmill desks on energy expenditure, sitting time and cardiometabolic health in adults.

BACKGROUND: As the health risks of sedentary working environments become more clear, greater emphasis on the implementation of walking interventions to reduce sitting time is needed. In this systematic review and meta-analysis, we investigate the role of treadmill-desk interventions on energy expenditure, sitting time, and cardiometabolic health in adults with sedentary occupations. METHODS: Relevant studies published in English were identified using CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed databases up to December 2020. Random effects meta-analysis models were used to pool study results. RESULTS: Thirteen relevant studies (six workplaces and seven laboratories) were found with a total of 351 participants. Pooled analysis of laboratory studies showed a significant increase in energy expenditure (105.23 kcal per hour, 95% confidence interval [CI]: 90.41 to 120.4), as well as metabolic rate (5.0 mL/kg/min, 95% CI: 3.35 to 6.64), among treadmill desk users compared to sitting conditions. No evidence of significant differences in blood pressure were found. In workplace studies, we observed a significant reduction in sitting time over a 24-h period (- 1.73 min per hour, 95% CI: - 3.3 to - 0.17) among users of treadmill desks, compared to a conventional desk. However, there were no evidence of statistically significant changes in other metabolic outcomes. CONCLUSIONS: Treadmill desks offer a feasible and effective intervention to increase energy expenditure and metabolic rate and reduce sitting time while performing work-related tasks. Future studies are needed to increase generalizability to different workplace settings and further evaluate their impact on cardiometabolic health.

Trends in Serum AST-to-ALT Ratio Among U.S. Adults: Analysis of the U.S. National Health and Nutrition Examination Survey.

Background: Using nationally representative data, we examined the age-, sex-, and ethnic-specific variation in the ratio of serum aspartate aminotransferase and alanine aminotransferase (AST-to-ALT ratio or AAR) of U.S. adults (20+ years). Understanding these subgroup differences in AAR will provide insight into population patterns of these ratios, which provide a basis for normative comparisons for the application of personalized diagnostic information to patients in the clinical setting. Methods: Data for this analysis are based on continuous cycles (1999-2016) of the National Health and Nutrition Examination Survey (NHANES). Results: Within the complete sample (n = 13,731), mean AST and ALT values were similar (∼25 U/L), with higher absolute values, but lower AAR, in males compared with females. From 1999-2000 to 2015-2016 there were consistent sex, age, and ethnic differences in the AAR. Specifically, the AAR for individuals 65+ years was markedly higher in all survey years, with subtle ethnic variation [Mexican Americans (0.95-1.04) Other Hispanic (1.0-1.09), Non-Hispanic White (1.05-1.11), Non-Hispanic Black (1.12-1.22), and Other Ethnicity (1.01-1.17)]. Sex-specific analysis reveals that the lower AAR observed among Mexican Americans is almost entirely accounted for by the markedly lower AAR in men. Conclusion: Future work is necessary to understand these subgroup variations in longer term studies with incident disease.

Associations between elevated kidney and liver biomarker ratios, metabolic syndrome and all-cause and coronary heart disease (CHD) mortality: analysis of the U.S. National Health and Nutrition Examination Survey (NHANES).

BACKGROUND: We examined the relationship between ratios of select biomarkers of kidney and liver function on all-cause and coronary heart disease (CHD) mortality, both in isolation, and in combination with metabolic syndrome (MetS), among adults (20 + years, n = 10,604). METHODS: Data was derived from the U.S. National Health and Nutrition Examination Survey (1999-2016) including public-use linked mortality follow-up files through December 31, 2015. RESULTS: Select biomarker ratios of kidney (UACR or albuminuria and BUN-CR) and liver (AST-ALT and GGT-ALP) function in isolation and in combination with MetS were associated with all-cause and CHD mortality. Compared to individuals with neither elevated biomarker ratios nor MetS (HR = 1.00, referent), increased risk of all-cause mortality was observed in the following groups: MetS with elevated UACR (HR, 95% CI = 2.57, 1.99-3.33), MetS with elevated AST-ALT (HR = 2.22, 1.61-3.07), elevated UACR without MetS (HR = 2.12, 1.65-2.72), and elevated AST-ALT without MetS (HR = 1.71, 1.35-2.18); no other biomarker ratios were associated with all-cause mortality. For cause-specific deaths, elevated risk of CHD mortality was associated with MetS with elevated UACR (HR = 1.67, 1.05-2.67), MetS with elevated AST-ALT (HR = 2.80, 1.62-4.86), and elevated BUN-CR without MetS (HR = 2.12, 1.12-4.04); no other biomarker ratios were associated with CHD mortality. CONCLUSION: Future longitudinal studies are necessary to examine the utility of these biomarker ratios in risk stratification for chronic disease management.