Outdoor fine particulate matter exposure and telomere length in humans: A systematic review and meta-analysis.

Although the association between changes in human telomere length (TL) and ambient fine particulate matter (PM2.5) has been documented, there remains disagreement among the related literature. Our study conducted a systematic review and meta-analysis of epidemiological studies to investigate the health effects of outdoor PM2.5 exposure on human TL after a thorough database search. To quantify the overall effect estimates of TL changes associated with every 10 µg/m3 increase in PM2.5 exposure, we focused on two main topics, which were outdoor long-term exposure and prenatal exposure of PM2.5. Additionally, we included a summary of short-term PM2.5 exposure and its impact on TL due to limited data availability. Our qualitative analysis included 20 studies with 483,600 participants. The meta-analysis showed a statistically significant association between outdoor PM2.5 exposure and shorter human TL, with pooled impact estimates (ß) of -0.12 (95% CI: -0.20, -0.03, I2= 95.4%) for general long-term exposure and -0.07 (95% CI: -0.15, 0.00, I2= 74.3%) for prenatal exposure. In conclusion, our findings suggest that outdoor PM2.5 exposure may contribute to TL shortening, and noteworthy associations were observed in specific subgroups, suggesting the impact of various research variables. Larger, high-quality studies using standardized methodologies are necessary to strengthen these conclusions further.

Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region.

Cardiometabolic diseases (CMDs) are the major types of non-communicable diseases, contributing to huge disease burdens in the Western Pacific region (WPR). The use of digital health (dHealth) technologies, such as wearable gadgets, mobile apps, and artificial intelligence (AI), facilitates interventions for CMDs prevention and treatment. Currently, most studies on dHealth and CMDs in WPR were conducted in a few high- and middle-income countries like Australia, China, Japan, the Republic of Korea, and New Zealand. Evidence indicated that dHealth services promoted early prevention by behavior interventions, and AI-based innovation brought automated diagnosis and clinical decision-support. dHealth brought facilitators for the doctor-patient interplay in the effectiveness, experience, and communication skills during healthcare services, with rapidly development during the pandemic of coronavirus disease 2019. In the future, the improvement of dHealth services in WPR needs to gain more policy support, enhance technology innovation and privacy protection, and perform cost-effectiveness research.

Survival nomograms for vulvar squamous cell carcinoma based on the SEER database and a Chinese external validation cohort.

OBJECTIVE: The aim of study was to construct a nomogram to effectively predict the overall survival (OS) and cancer-specific survival (CSS) for patients with vulvar squamous cell carcinoma (VSCC). METHODS: The training cohort consisted of 5405 patients with VSCC, extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Eighty-four patients with VSCC were selected from the disease database of the Shengjing Hospital of China Medical University from 2014 to 2020, and enrolled as the external validation cohort. Significant independent prognostic factors were identified using Cox regression analysis and used to develop nomograms to predict 1-, 3-, and 5-year OS and CSS in patients with VSCC. RESULTS: The nomogram predicting OS was developed based on tumor size, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage, regional lymph node involvement, distant metastases, surgery, chemotherapy, age, and race. The nomogram for CSS was constructed using the similar factors, excluding race but including marital status. The nomogram for 1-, 3-, and 5-year OS demonstrated robust performance with receiver operating characteristic curves (AUCs) exceeding 80% (0.86, 0.84, and 0.82), outperforming the FIGO staging alone (0.77, 0.75, and 0.72). Similarly, for CSS, our nomograms achieved larger AUCs of 0.89, 0.88, and 0.86 compared with FIGO staging alone (0.81, 0.79, and 0.78). CONCLUSION: The nomograms more accurately predict prognosis than simple FIGO staging. Moreover, the nomograms developed in this study provide a convenient, operable, and reliable tool for individual assessment and clinical decision-making for patients with VSCC.

Shift work and risk of incident gastroesophageal reflux disease: the association and mediation.

Introduction: Shift work has become an increasingly common work mode globally. This study aimed to investigate the association between shift work and the risk of incident gastroesophageal reflux disease (GORD), an upward gastrointestinal disorder disease worldwide, and to explore the mediating factors. Method: A total of 262,722 participants from the UK Biobank free of GORD and related gastrointestinal diseases were included to investigate the association and potential mediators between shift work and incident GORD. Multivariate-adjusted Cox models were used to evaluate the association between shift work status and GORD incidence. Results: Compared to non-shift workers, shift workers had a 1.10-fold greater risk of incident GORD [95% confidence intervals (CIs): 1.03, 1.18], after adjusting for a range of potential confounders. However, the excess risk of GORD attenuated to the null after further adjusting for selected mediators. Specifically, the association was mediated by sleep patterns (25.7%), healthy behaviors (16.8%), depressive symptoms (20.2%), chronic conditions (13.3%), and biological factors (17.6%). After adjustment for all the mediators together, the association was attenuated by 71.5%. Discussion: Our findings indicated that long-term shift workers may have a higher risk of incident GORD, yet the excess risk may be explained by poor sleep quality, unhealthy behaviors, depressive symptoms, etc. This has positive implications for protecting the health of shift workers.

Association of dietary patterns with general and central obesity among Chinese adults: a longitudinal population-based study.

BACKGROUND: Limited evidence exists for the association between dietary patterns and later obesity phenotypes among Chinese adults. This longitudinal study aimed to evaluate associations of dietary patterns with general and central obesity in Chinese adults. METHODS: Based on the China Health and Nutrition Survey (CHNS) waves 2004 and 2015, the study was conducted on 4207 adult men and women (age range: 18-65 years). Dietary intakes were assessed by three consecutive 24-h dietary recalls, and dietary patterns were identified using exploratory factor analysis. Longitudinal associations of dietary patterns with general and central obesity were evaluated using logistic regression analyses. RESULTS: The prevalence rates of general and central obesity were 14.2% and 42.1%, respectively. Factor analysis extracted three major dietary patterns: "traditional southern," "modern," and "traditional northern." After adjustment for potential confounders, adults in the highest quartile of the traditional southern dietary group were less likely to develop over 10 years general (odds ratio [OR] = 0.50, 95% confidence interval [95%CI]: 0.39, 0.65) and central (OR = 0.52, 95%CI: 0.43, 0.63) obesity compared to those in the lowest quartile group. The modern dietary pattern was not significantly associated with general and central obesity. Adherence to the traditional northern dietary pattern increased the chance of both general and central obesity (OR = 1.61, 95%CI: 1.23, 2.10; OR = 1.64, 95%CI: 1.36, 1.98) after 10 years. CONCLUSIONS: Our study provides longitudinal evidence for associations between dietary patterns and later obesity phenotypes among Chinese adults. Our findings may guide the development of evidence-based preventive nutrition interventions to control the obesity epidemic.

Associations between Household Solid Fuel Use, Obesity, and Cardiometabolic Health in China: A Cohort Study from 2011 to 2018.

This study aims to explore the longitudinal relationship between solid fuel use and CMD incidence based on a nationally representative follow-up cohort study. A total of 6038 participants of the China Health and Retirement Longitudinal Study (CHARLS) were enrolled in the study. CMD is a cluster of diseases that include heart disease, stroke, and type 2 diabetes. Cox proportional-hazards regression models were used to examine the association between solid fuel use and the incidence or multimorbidity of CMD. The interactions between overweight or obesity and household air pollution on CMD incidence were also investigated. In the present study, solid fuel use from cooking or heating, separately or simultaneously, was positively associated with CMD incidence. Elevated solid fuel use was significantly associated with a higher risk of CMD incidence (HR = 1.25, 95% CI: 1.09, 1.43 for cooking; HR = 1.27, 95% CI: 1.11, 1.45 for heating). A statistically significant interaction between household solid fuel and OW/OB on the incidence of CMD and Cardiometabolic multimorbidity was also observed (p < 0.05). Our findings show that household solid fuel is a risk factor for the incidence of CMD. Therefore, reducing household solid fuel use and promoting clean energy may have great public health value for the prevention of CMD.

Association of Serum Galectin-3-Binding Protein and Metabolic Syndrome in a Chinese Adult Population.

Background: Galectin-3-binding protein (GAL-3BP) is a ubiquitous and multifunctional secreted glycoprotein, which functions in innate immunity and has been highlighted as a potential mediator of adipose inflammation in obesity. In this study, we aimed to identify whether GAL-3BP is a novel biological marker for metabolic syndrome (MetS). Methods: The biochemical and anthropometric variables of the 570 participants in this study were evaluated using standard procedures. Their serum GAL-3BP levels were measured using enzyme-linked immunosorbent assay (ELISA), while the association between the glycoprotein and MetS was analyzed using multiple logistic regression analyses. Moreover, an experimental MetS model was established. The expression of GAL-3BP in serum and adipose tissue was measured using ELISA and western blotting. Lipid accumulation was determined with the use of immunohistochemistry and immunofluorescent staining. Results: The serum GAL-3BP level was found to be positively associated with MetS. The logistic regression analyses demonstrated that participants expressing the upper levels of GAL-3BP were more likely to develop MetS than those expressing less of the glycoprotein (OR = 2.39, 95%CI: 1.49, 3.83). The association between the serum GAL-3BP level and MetS was found preferentially in postmenopausal women (OR = 2.30, 95%CI: 1.31, 4.05). In addition, GAL-3BP was increased in the serum and visceral adipose tissue (VAT) of high fat diet (HFD) mice. Moreover, GAL-3BP was highly expressed in VAT macrophages. Conclusions: This study confirmed serum GAL-3BP to be positively associated with MetS, highlighting it as a useful biological marker of MetS in Chinese participants.

Solidarity and HIV Testing Willingness During the COVID-19 Epidemic: A Study Among Men Who Have Sex With Men in China.

Background: Solidarity, such as community connectedness and social cohesion, may be useful in improving HIV testing uptake among men who have sex with men (MSM). This study aimed to evaluate the impact of solidarity on HIV testing before the coronavirus disease 2019 (COVID-19) and HIV testing willingness during COVID-19 among MSM in China. Materials and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and solidarity items' information from the participants. We first used factor analysis to reveal the principal component of the solidarity items and then used logistic regression to study the impact of solidarity on HIV testing, by adjusting the possible confounding factors, such as age and education. Results: Social cohesion and community connectedness were revealed by the factor analysis. MSM with high community connectedness were more willing to undergo HIV testing before the epidemic adjusted by age [odds ratio (OR): 1.07, 95% CI: 1.01-1.13]. The community connectedness was also related to the willingness of HIV testing during the epidemic, with adjustments of 1.09 (95% CI: 1.03-1.15). People who did not test for HIV before the COVID-19 epidemic were more willing to have the HIV test during the epidemic, which was correlated with the community connectedness, and the OR value was 1.14 (95%: 1.03-1.25). Conclusion: A high level of community connectedness helped to increase the HIV testing rate before COVID-19 and the willingness of HIV testing during the epidemic among MSM. Strategies can strengthen the role of the community in the management and service of MSM.

Serum galectin-3BP as a novel marker of obesity and metabolic syndrome in Chinese adolescents.

INTRODUCTION: Childhood obesity (OB) and metabolic syndrome (MetS) have become a worldwide health problem. Comparative proteomic approaches are widely used in human OB to analyze protein changes in blood plasma. The present study determined the galectin-3 binding protein (galectin-3BP) expression level in different weight categories and assessed the associations between galectin-3BP and OB and MetS. RESEARCH DESIGN AND METHODS: The current study included 932 Chinese adolescents 13-18 years of age. The biochemical and anthropometric variables of all the subjects were evaluated using standardized procedures. The differentially expressed proteins (DEPs) were investigated among 60 adolescents (20 normal weight, 20 overweight and 20 obese) using tandem mass tag (TMT) quantitative proteomics. The serum galectin-3BP level was measured using ELISA. The associations between galectin-3BP and OB and MetS were analyzed in 932 adolescents using multiple logistic regression analyses. RESULTS: A significant DEP, galectin-3BP, can effectively separate the obese from the normal weight group using TMT. Adolescents in tertile 3 of galectin-3BP, when compared with adolescents in the tertile 1, were positively associated with OB (OR=3.32, 95% CI 1.79 to 6.16) and MetS (OR=3.28, 95% CI 1.30 to 8.26). The receiver operating characteristic curve for galectin-3BP in subjects with MetS indicated that the area under the curve was 0.85 (95% CI 0.79 to 0.91). CONCLUSIONS: This study confirmed an association between galectin-3BP and OB in Chinese adolescents, and galectin-3BP was also positively associated with MetS, and thus might be useful for identifying adolescents with MetS.

Complement C1q as a Potential Biomarker for Obesity and Metabolic Syndrome in Chinese Adolescents.

Background: Complement C1q (C1q) has been confirmed to be related to obesity, metabolic syndrome (MetS), and its components. However, human data regarding the associations are relatively scarce. This study aimed to investigate associations of C1q with obesity as well as MetS in Chinese adolescents. Methods: A total of 1,191 Chinese adolescents aged 13-18 years were enrolled in this study. The biochemical and anthropometric variables of all the subjects were evaluated using standardized procedures. C1q was measured using the immunoturbidometric assay. The relationship between C1q and obesity or MetS was analyzed using multiple regression analyses. Results: Obesity was more prevalent among participants in the highest tertile than in the lowest tertile of C1q levels. The highest tertile of C1q was related to a greater effect on the risk of MetS, and its trend test was statistically significant. Except for hyperglycemia, the prevalence of other components of MetS significantly increased relative to an increase in C1q tertile. Receiver operating characteristic (ROC) curve analysis of C1q for predicting adolescents with MetS illustrated that the area under the curve (AUC) was 0.82 [95% confidence interval (CI): 0.76, 0.88; P<0.001] in the total population after adjusting for confounders. Conclusions: This study observed a significantly higher prevalence of obesity and MetS features in adolescents with high C1q. The findings of the current study also reported a significant relationship between C1q levels and MetS components [except for fasting plasma glucose (FPG)] in Chinese adolescents. C1q may represent a biomarker for predicting obesity or MetS in adolescents.

Does Physical Activity-Based Intervention Improve Systemic Proinflammatory Cytokine Levels in Overweight or Obese Children and Adolescents? Insights from a Meta-Analysis of Randomized Control Trials.

OBJECTIVES: The purpose of this research was to conduct a meta-analysis of the role that physical activity (PA) plays in influencing the critical proinflammatory cytokine levels associated with overweight/obese children and adolescents to explore the effectiveness of exercise intervention within this population. METHODS: With searches of the PubMed, EMBASE, and CENTRAL databases, we updated our meta-analysis up to November 2018. The randomized controlled trials (RCT) evaluated the ability of exercise training to increase the following factors in children and/or adolescents classified as obese or overweight: tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP). RESULTS: Eleven RCT comprising 623 children and/or adolescents who were obese or overweight (i.e., 393 with PA and 230 controls) were suitable for use in this study. The meta-analysis showed that PA in general was associated with a significant reduction of CRP levels (mean difference = -0.45 mg/L, p = 0.02) in overweight/obese children and adolescents. Based on 115 overweight and obese youths, this study suggests that PA does not significantly mitigate IL-6 levels (mean difference = -0.39 pg/mL, p = 0.08), although there was a trend towards a reduction. Additionally, no close connection was observed between PA and TNF-α levels at 0.04 pg/mL (p = 0.78). Moreover, meta-regression analysis revealed a statistical association between CPR levels and changes in BMI or changes in adiponectin; likewise, IL-6 levels dramatically impacted the effect of exercise on changes in adiponectin. CONCLUSIONS: PA was associated with significantly reduced CRP levels, whereas there was no significant association with IL-6 or TNF-α in overweight/obese children or adolescents; however, there was a trend towards a reduction of IL-6.

miR-548d-3p inhibits osteosarcoma by downregulating KRAS.

MicroRNAs (miRNAs) are known to be associated with certain cancers, including osteosarcoma. We examined osteosarcoma tissues and cell lines, and found that most expressed lower levels of miR-548d-3p than adjacent tissues and normal cell lines. KRAS was identified as a potential target gene of miR-548d-3p. In osteosarcoma cells, miR-548d-3p exerted tumor-suppressive effects by downregulating KRAS. Functional assays revealed that miR-548d-3p mimics dramatically reduced cell growth and migration in vitro. These results suggest that miR-548d-3p mimics could be applied for osteosarcoma treatment.

Plasma cholinesterase is associated with Chinese adolescent overweight or obesity and metabolic syndrome prediction.

Purpose: To determine the plasma concentrations of butyrylcholinesterase (BChE), also known as pseudocholinesterase, in different weight categories of adolescents, and to explore the possible association between plasma BChE and overweight (OW), obesity, and metabolic syndrome (MetS) in Chinese adolescents. Patients and methods: This cross-sectional study included 1,236 Chinese adolescents (194 obese [OB], 188 OW, 732 normal weight [NW], and 122 underweight [UW]). The biochemical variables and anthropometric variables of the study participants were evaluated. Plasma BChE level was measured by DGKC method. Results: OB was associated with a higher prevalence of upper strata plasma BChE levels when compared with the BChE levels in UW, NW, and OW group. A logistic regression analysis showed that plasma BChE was positively associated with the OB group when compared with the NW group. Boys in the OW group, but not the OB group, had a significantly higher prevalence of upper stratum of BChE levels. Plasma triglyceride, total cholesterol, low-density lipoprotein-cholesterol, and ApoB levels were positively associated with the upper stratum of BChE levels when compared with lower stratum. MetS and most of its components were more prevalent among subjects with upper stratum rather than lower stratum BChE levels. Receiver operating characteristic curves for plasma BChE in subjects with MetS indicated that the AUC was 0.80 (95%CI:0.70-0.90,P<0.001) and 0.89 (95%CI:0.82-0.95,P<0.001) in girls and boys, respectively. After adjusting for age, the multivariate-adjusted odds ratio for MetS in the upper stratum of BChE levels was 8.73 (95%CI: 3.49-21.84) in the boys cohorts and also in the girls cohorts (OR=1.71, 95%CI: 1.35-21.70). Conclusion: This study confirmed an association between BChE levels and weight status in Chinese adolescents, and demonstrated that the upper strata of plasma BChE levels were associated with being OW, and even more highly associated with obesity. Plasma BChE levels were positively associated with MetS and its components and could be useful for identifying adolescents with MetS.

Relationship between bone mineral density and the risk of breast cancer: a systematic review and dose-response meta-analysis of ten cohort studies.

PURPOSE: The evidence from recent epidemiological studies investigating the relationship between bone mineral density (BMD) and the risk of breast cancer (BC) remains inconsistent. MATERIALS AND METHODS: The PubMed, EMBASE, and Web of Science databases were comprehensively searched by two independent authors to identify related cohort studies from the inception of the databases through January 31, 2018. Similarly, two researchers separately extracted the data from the selected studies, and any differences were resolved by discussion. Summarized relative risks (RRs) and 95% CIs were summarized via inverse variance weighted random-effects meta-analysis. Heterogeneity among studies was assessed with the I 2 statistic. RESULTS: Ten studies with 1,522 BC patients among 81,902 participants were included in this meta-analysis. Compared to the participants with the lowest BMD at the lumbar spine, those with the highest BMD had a significantly lower RR for BC (RR =0.75; 95% CI =0.60-0.93; I 2=23.0%). In the subgroup analyses, although the directions of the results were consistent with those of the main findings, not all showed statistical significance. We failed to detect an association between BMD at the femoral neck or total hip and the risk of BC (RR =0.94; 95% CI =0.66-1.33; I 2=72.5%). Furthermore, the results of the dose-response analysis did not show a significant association between BMD at the lumbar spine, femoral neck, or total hip and the risk of BC. Funnel plot and statistical analyses showed no evidence of publication bias. CONCLUSION: There is no relationship between BMD and the risk of BC. More prospective cohort studies are warranted to further investigate this issue.

Dietary pattern is associated with obesity in Chinese children and adolescents: data from China Health and Nutrition Survey (CHNS).

BACKGROUND: Associations of dietary patterns in Chinese adolescents and children with later obesity have not previously been investigated. The purpose of the present study was to evaluate the associations between dietary patterns and the risk of obesity in Chinese adolescents and children by using a longitudinal design. METHODS: Data from the China Health and Nutrition Survey (CHNS), a nationally representative survey, were used for our analysis. 489 participants 6-14 years of age were followed from 2006 to 2011. Factor analysis was used to identify the dietary patterns in Chinese adolescents and children. Ordered logistic regression models were used to examine the association between dietary patterns and later obesity. RESULTS: Two dietary patterns were revealed by factor analysis, the traditional Chinese dietary pattern (with high intake of rice, vegetables, poultry, pork and fish and the modern dietary pattern (with high intake of wheat, processed meat and fast food). Children in the highest quartile and the second-highest quartile of the traditional Chinese dietary pattern was inversely associated with later obesity compared with children in the lowest quartile over 5 years (OR = 0.19, 95%CI: 0.09, 0.40 for Q4; OR = 0.47, 95%CI: 0.33, 0.67 for Q3); Children in the highest quartile of the modern dietary pattern was positively associated with later obesity compared with children in the lowest quartile over 5 years (OR = 2.02, 95%CI: 1.17, 3.48). CONCLUSIONS: Dietary patterns in Chinese adolescents and children are associated with later obesity. These findings further confirm the importance of children's dietary patterns in later obesity and lay groundwork for dietary culture-specific interventions targeted at reducing rates of obesity in children and adolescents.

Psychosocial Correlates of Food Addiction and Its Association with Quality of Life in a Non-Clinical Adolescent Sample.

BACKGROUND: Most studies related to food addiction have focused on assessing food addiction among adult populations. However, evidence in adolescents has been limited. The aim of this study was to investigate the prevalence of food addiction in a non-clinical adolescent sample. Psychosocial correlations of food addiction and associations with different quality of life dimensions were also tested. METHODS: The sample included 593 Chinese adolescents (51.9% female; age range: 13⁻17 years). All participants provided sociodemographic information and completed questionnaires regarding food addiction, depression, self-esteem, loneliness, psychosocial problems, and quality of life (QoL). RESULTS: The prevalence of food addiction was 6.91% in our sample. A multivariable logistic regression indicated that food addiction was associated with depression (AOR = 2.58; 95% CI: 1.32⁻5.05), low self-esteem (AOR = 2.75; 95% CI: 1.31⁻5.78), and loneliness (AOR = 2.30; 95% CI: 1.14⁻4.65). After multivariable adjustments for sociodemographic and psychological variables, food addiction was associated with lower overall QoL and psychosocial health of QoL. CONCLUSIONS: Food addiction may be common among Chinese adolescents. Food addiction was associated with depression, low self-esteem, and loneliness. Lastly, food addiction was also associated with lower overall QoL and psychosocial health of QoL. Future public health programs and interventions consider targeting the factors associated with food addiction to increase healthy eating behaviors among adolescents.

Who is more likely to be obese or overweight among siblings? A nationally representative study in rural China.

BACKGROUND: The aims of this study were to determine the association between sibling rank and childhood obesity among children ≤ 5 years of age in rural China, and to investigate the effect of child gender and the obesity status of other siblings on this association. METHODS: Data from the China Family Panel Studies, a nationally representative survey, was used for the analysis. Sibling rank was defined as the birth order of all children with the same biological mother. A total of 1116 children ≤ 5 years of age were divided into four groups: children without siblings, first-born children, second-born children, and third-born or younger children. For each child, the body mass index and standard deviation (BMI z score) was calculated according to WHO standards; children with BMI z scores > 2 were classified as obese or overweight (ObOw). Logistic regression models were used to estimate the association between sibling rank and ObOw status, and the possible influence of gender and ObOw status among other siblings. RESULTS: The second and third-born or younger children had a significantly higher risk of becoming ObOw than children without siblings (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.07-1.63 and OR:1.38, 95% CI: 1.17-1.63, respectively). Specifically, female second-born children and male third-born or younger children had a significantly higher risk of ObOw (OR: 1.50, 95% CI: 1.11-2.01 and OR: 1.57, 95% CI: 1.07-2.32, respectively). Having an ObOw sibling increased the probability of being ObOw and the magnitude of the effect was larger if siblings were younger. CONCLUSIONS: Sibling rank was shown to be associated with ObOw status among children 0-5 years of age in rural China. Our findings can help healthcare practitioners and authorities to identify children at risk of obesity. Future studies should focus on the mechanisms of this association.