Association of changes in plant-based diet consumption with all-cause mortality among older adults in China: a prospective study from 2008 to 2019.

OBJECTIVES: To examine the association of changes in plant-based diet consumption with all-cause mortality among older adults in China. DESIGN: Cohort study. SETTING: This cohort study of 11 years used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a long-term, nationwide survey covering 23 provinces in China. PARTICIPANTS: A total of 7843 older participants aged ≥60 years were included in this study. MEASUREMENTS: Changes in plant-based diets consumption (2008-2011) were assessed by 3 graded plant-based diet indices, including an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). The main outcome was all-cause mortality. Multivariable-adjusted Cox proportional-hazards models were fitted to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality for changes in PDI, hPDI, and uPDI. RESULTS: A total of 7843 participants (mean [SD] age, 82.2 [10.9] years; 3588 [45.7%] men) were included in this study. During a median (IQR) of 9 (5-10) years of follow-up, 3749 deaths were documented. Compared with older adults whose plant-based diet indices were relatively stable, older adults with the greatest decrease (quintile 1) in PDI, hPDI, and uPDI had respectively 32% (95% CI, 19%-47%) higher, 21% (95% CI, 9%-33%) higher, and 10% (95% CI, 4%-21%) lower risk of death. Compared with older adults whose diet indices were relatively stable, older adults with the greatest increase (quintile 5) in uPDI had a 13% higher risk of death (95% CI, 1%-21%), while no significant associations of the increased PDI and hPDI with all-cause mortality were observed. CONCLUSION: Maintaining the consumption of overall and healthful plant-based diets, and decreasing the consumption of an unhealthful plant-based diet can be beneficial in preventing or delaying premature death among Chinese older adults.

Association of social isolation and loneliness with the risk of hypertension in middle aged and older adults: Findings from a national representative longitudinal survey.

BACKGROUND: Social isolation and loneliness have been proved to be associated with many adverse health outcomes, but their influence on hypertension remains unclear. This study aimed to assess the relationship of social isolation and loneliness with hypertension risk among middle-aged and older adults in China. METHODS: We used data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were assessed for social isolation and loneliness at baseline, and hypertension was identified by self-report and blood pressure measurement at follow-up in 2015. Binary logistic regression analyses were conducted to assess the association of social isolation and loneliness with the risk of hypertension. RESULTS: A total of 3711 residents were included. 13.7 % of the participants had high level of social isolation and 18.1 % felt lonely. During the four-year follow up period, 651 participants developed hypertension. People with high level of social isolation had an increased risk of hypertension (odds ratio [OR]: 1.40, 95 % confidence interval [CI]: 1.09-1.79). Similar results were found between social isolation score and hypertension risk (OR: 1.14, 95 % CI: 1.04-1.26). No significant association between loneliness and hypertension or any interaction effect of social isolation and loneliness on hypertension were observed. LIMITATIONS: Limited by the structure of questionnaire, some of the information was derived by self-report, which may lead to recalling bias. CONCLUSION: Social isolation, rather than loneliness was associated with hypertension for middle aged and older adults. Social support needs to be strengthened for hypertension prevention in community.

Effect of Qigong exercise on motor function in stroke patients: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Motor impairment is one of the most common defects after stroke, which could seriously affect the life quality of stroke patients. Exercise intervention gradually becomes a popular alternative rehabilitation therapy because of its safety and applicability. OBJECTIVES: To systematically assess the effect of Qigong exercise on motor function in stroke patients. METHODS: Randomized controlled trials that evaluated the effect of Qigong on motor function of stroke patients were obtained from PubMed and Chinese National Knowledge Infrastructure through May 2022. Mean values and standard deviations of the post-intervention score in both experimental group and control group were collected to calculate the mean difference (MD) and corresponkding 95% confidence interval (95% CI) of each study, which were quantificationally summarized using the Review Manager 5.3 software. RESULTS: Nineteen randomized controlled trials enrolling 1487 stroke patients were included. Pooled results indicated that Qigong exercise had beneficial effect on balance function (Berg Balance Scale [MD: 7.56, 95% CI: 4.09-11.02]), limb motor function (Fugl-Meyer Assessment [total score: MD: 7.54, 95% CI: 6.38-8.69; upper limb: MD: 3.57, 95% CI: 0.71-6.43; lower limb: MD: 2.44, 95% CI: 0.59-4.29]) and walking function (6-min walking test [MD: 62.21, 95% CI: 11.70-112.73]) of stroke patients. It was also found to be associated with an improvement in trunk function as indicated by the Trunk Impairment Scale. CONCLUSIONS: Available evidence supported potential benefits of Qigong exercise for improving motor functions of stroke patients. As a safe and widely applicable exercise, Qigong is worthy of further promotion in the rehabilitation of stroke patients.

Effect of Qigong exercise on non-motor function and life quality in stroke patients: A systematic review and meta-analysis.

BACKGROUND: Qigong have a positive impact on the rehabilitation of motor function in stroke survivors, but there is no consensus on the effectiveness of Qigong on activities of daily living (ADL), neurological function, and life quality for patients with stroke. We aimed to quantitatively evaluate the effect of Qigong on non-motor function and life quality in stroke patients. METHODS: Electronic literature searches were performed for randomized controlled trials on this topic using PubMed and China National Knowledge Infrastructure through August 2022. The primary outcome measures were the Barthel Index, neurological deficit score (NDS), and Stroke-Specific Quality of Life Scale (SSQLS). A random-effects model was used to calculate the pooled mean difference (MD) with 95% confidence interval (CI). RevMan 5.4 software was used for meta-analysis. RESULTS: A total of 16 eligible randomized controlled trials with 1253 stroke patients were included. As indicated by the Barthel Index, Qigong was associated with the improvement in daily living activities of stroke patients (MD: 10.72, 95% CI: 5.88∼15.57). It was also found that Qigong was helpful in improving life quality (SSQLS, MD: 14.41, 95% CI: 5.56∼23.25) and reducing NDSs among them (NDS, MD: -4.56, 95% CI: -6.99∼-2.14). After sensitivity analysis, the effect of Qigong on these functions and life quality did not change significantly. By subgroup analysis of intervention duration, we found that long-term intervention (MD: 11.83, 95% CI: 2.80∼20.86) had a better effect on the improvement of daily living activities than short-term intervention (MD: 10.07, 95% CI: 6.15∼14.00) (pfor subgroup differences  = .001). CONCLUSIONS: Pooled results suggested that Qigong had beneficial effects on ADL, neurological function, and life quality in stroke patients, which may provide an option for their rehabilitation.

The Association Between Solid Fuel Use and Visual Impairment Among Middle-Aged and Older Chinese Adults: Nationwide Population-Based Cohort Study.

BACKGROUND: Indoor air pollution has been reported to have adverse effects on the eye; however, the health effects of exposure to cooking with solid fuels on visual impairment remain unclear in China. OBJECTIVE: We aimed to examine the association between cooking with solid fuels and visual impairment, including distance visual impairment (DVI) and near visual impairment (NVI). METHODS: Data were obtained from the China Health and Retirement Longitudinal Study, a nationwide survey of adults aged over 45 years who were enrolled in 2011 (Wave 1) and followed up in Wave 2 (2013), Wave 3 (2015), and Wave 4 (2018). We used Cox proportional hazards models to determine the association between solid fuels use and visual impairment. Additionally, the impact of switching cooking fuel types on vision function were examined through wave-specific data analysis (Wave 1 and Wave 4). Interaction and subgroup analyses were performed to explore the potential effect modifiers. Data were collected using the stratified multistage random sampling method and further analyzed using SPSS 27.0 and R 4.2.1 statistical software packages. RESULTS: A total of 9559 middle-aged and older Chinese adults without visual impairment at baseline were included in the study, with 51.2% (n=4914) of the participants reporting that they cooked with solid fuels. During the follow-up period, 2644 (27.5%) and 3130 (32.6%) participants developed DVI and NVI, respectively. Compared with the clean fuel users, participants who cooked with solid fuels had a higher risk of DVI (hazards ratio [HR] 1.38, 95% CI 1.28-1.50) and NVI (HR 1.18, 95% CI 1.10-1.27). In addition, switching the cooking fuel type from clean to solid fuels was associated with an elevated risk of DVI (HR 1.51, 95% CI 1.15-1.98) and NVI (HR 1.39, 95% CI 1.06-1.82) compared to persistently using clean fuels during the follow-up period, although no protective effect of switching from solid to clean fuels on NVI was found (P=.52). In subgroup analysis, we found that cooking with solid fuels increased the risk of DVI in participants younger than 65 years (HR 1.41, 95% CI 1.28-1.55), men (HR 1.45, 95% CI 1.28-1.65), urban residents (HR 1.41, 95% CI 1.08-1.75), and smokers (HR 1.43, 95% CI 1.25-1.64). By contrast, negative effects of cooking with solid fuels on NVI were found in nonsmokers (HR 1.21, 95% CI 1.11-1.33) and urban residents (HR 1.20, 95% CI 1.10-1.37). CONCLUSIONS: Cooking with solid fuels was associated with an increased risk of visual impairment among middle-aged and older Chinese adults. These findings indicate that promoting the utilization of clean fuels is conducive to reducing the burden of visual impairment for the public.

Association between neck circumference and diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: Despite that several original researchers have investigated the association between neck circumference (NC) and the risk of diabetes mellitus (DM), their results remain controversial. This review aimed to quantitatively determine the risk of DM in relation to the NC. METHODS: We conducted a literature search of PubMed, Embase, and the Web of Science from these databases' inception through September 2022 to identify observational studies that examined the association between NC and the risk of DM. A meta-analysis of the random-effects model was applied to combine the results of the enrolled studies. RESULTS: Sixteen observational studies involving 4,764 patients with DM and 26,159 participants were assessed. The pooled results revealed that NC was significantly associated with the risk of type 2 DM (T2DM) (OR = 2.17; 95% CI: 1.30-3.62) and gestational DM (GDM) (OR = 1.31; 95% CI: 1.17-1.48). Subgroup analysis revealed that after controlling for BMI, the relationship between the NC and T2DM remained statistically significant (OR = 1.94; 95% CI: 1.35-2.79). Moreover, the pooled OR of T2DM was found to be 1.16 (95% CI: 1.07-1.27) for an increment per each centimeter in the NC. CONCLUSIONS: Integrated epidemiological evidence supports the hypothesis that a greater NC is associated with an increased risk of T2DM and GDM.

Association of social participation and psychological resilience with adverse cognitive outcomes among older Chinese adults: A national longitudinal study.

BACKGROUND: Limited epidemiological evidence exists regarding the association of social participation and psychological resilience with cognitive health. This study aimed to comprehensively investigate the effects of social participation and psychological resilience on adverse cognitive outcomes among older adults in China. METHODS: We used two waves (2011 and 2014) of data from the Chinese Longitudinal Survey of Health and Longevity (CLHLS), and 9765 respondents were eligible for the subsequent screening for the present prospective analysis. The Cox proportional hazards model was utilized to examine the association of social participation and psychological resilience with cognitive impairment, cognitive decline and greater cognitive decline. The restricted cubic spline plots were applied to clarify the dose-response relationships between them. RESULTS: Compared to those with low social participation, participants with high social participation had a lower hazard ratio (HR) of 0.72 (95 % confidence interval [CI]: 0.59-0.89) for cognitive impairment, 0.85 (95 % CI: 0.76-0.94) for cognitive decline and 0.78 (95 % CI: 0.67-0.90) for greater cognitive decline. Participants with high psychological resilience had an HR of 0.77 (95 % CI: 0.63-0.95) for cognitive impairment 0.85 (95 % CI: 0.76-0.94) for cognitive decline and 0.85 (95 % CI: 0.73-0.98) for greater cognitive decline compared with those with low psychological resilience. Similar effects were observed for social participation score and psychological resilience score. The dose-response analysis also showed that the risk of adverse cognitive outcomes decreased gradually with increasing social participation scores and psychological resilience scores. Additionally, the multiplicative interaction between social participation and psychological resilience was not significant. LIMITATION: All information was collected by self-report, which may lead to biases in the process of information collection. CONCLUSION: In this study, social participation and psychological resilience were independently associated with a lower risk of adverse cognitive outcomes, and therefore both need to be considered as broader measures to preserve cognitive health among older Chinese adults.

Miscarriage, stillbirth and the risk of diabetes in women: A systematic review and meta-analysis.

AIMS: Whether women with a history of miscarriage or stillbirth have an increased risk of diabetes is inconclusive. We aimed to systematically assess the association between them. METHODS: We searched PubMed, Web of Science and Scopus through November 2022. Random-effect model for meta-analysis was applied to calculate pooled odds ratios and corresponding 95 % confidence intervals (CIs) when heterogeneity was > 40 %. RESULTS: Thirteen cohort studies and eight case-control studies with a total of 529,990 participants were included. Women ever experiencing a miscarriage had a 1.15-fold risk of non-gestational diabetes (95% CI: 1.02-1.28) and a 1.62-fold risk of gestational diabetes (95% CI: 1.32-1.98) compared to those never experiencing a miscarriage. Of them, women with three or more miscarriages had a 1.99-fold risk of non-gestational diabetes (95% CI: 1.36-2.91). The risk of non-gestational diabetes among women ever experiencing a stillbirth was 1.21 times compared with those never experiencing a stillbirth (95% CI: 1.03-1.41). Pooled results did not support a stable association between stillbirth and gestational diabetes risk (odds ratio:1.91, 95% CI: 1.00-3.64). CONCLUSIONS: A history of miscarriage or stillbirth was associated with an increased risk of diabetes in women. Future studies are needed to explore whether prediabetic metabolic conditions contribute to this association.

Meta-analysis of the association between periodontal disease, periodontal treatment and carotid intima-media thickness.

Periodontal disease is a major threat to oral health and would further contribute to systemic diseases without timely control. We aimed to evaluate the relation between periodontal disease, periodontal treatment and carotid intima-media thickness (CIMT) based on available epidemiological and clinical evidence. PubMed and Scopus were searched for relevant studies through May 2021. Observational studies reporting risk estimates with 95% confidence intervals (95% CIs) for the association between periodontal disease (including periodontitis and gingivitis) and risk of increased CIMT (defined as CIMT value that exceeded the cut-off value of clinical and prognostic significance), as well as interventional studies providing mean values with standard deviations of CIMT before and after periodontal intervention, were included. Random-effect models for meta-analysis were used to calculate the summary effect estimates with 95% CIs. A total of 406 citations were retrieved from electronic databases and 45 full-text articles were screened, leaving 11 articles using ultrasound to measure CIMT with 8744 participants included. Pooled results of seven cross-sectional studies involving 8558 participants indicated that compared to those without periodontitis, patients with periodontitis and those with severe periodontitis had an odds ratio of 1.42 (95% CI: 1.16, 1.75) and 1.70 (95% CI: 1.24, 2.33) for increased CIMT, respectively. Although publication bias was detected in these results, odds ratios corrected by the trim-and-fill method were still statistically significant. Results of four non-randomized controlled trials with 186 patients suggested that periodontal intervention may help reduce CIMT in patients with periodontal disease in the short term. Periodontitis, especially severe periodontitis, was significantly associated with the risk of increased CIMT. Periodontal intervention might help slow the progression of carotid intima-media thickening in patients with periodontal disease in the short term.

Adherence to the Chinese Food Pagoda in the High-Risk Population of Non-communicable Diseases Aged 35-59 in Central China.

Objectives: A healthy dietary habit is essential for preventing non-communicable diseases (NCDs). We aimed to assess the adherence to the Chinese Food Pagoda (CFP) proposed in the Chinese Dietary Guidelines 2016 in the high-risk population of NCDs in central China. Methods: A cross-sectional study was conducted in two large enterprises (totally 3,016 employees) from October to December 2019 in Hubei Province (central China). The high-risk population of NCDs was identified by physical examination, laboratory test and face-to-face questionnaire survey according to the National Norms for Prevention and Control of Non-communicable Diseases issued by the Chinese government. We assessed the deviation of real diet from the CFP recommended diet in the high-risk population of NCDs. Results: A total of 821 participants aged 35-59 years old with at least one high-risk factor of NCDs were enrolled in our study. Of them, 53.8% were daily smokers, 49.6% had elevated blood cholesterol, 31.4% were centrally obese, 23.3% had high normal blood pressure, and 3.5% had impaired fasting glucose. Significant disparity was detected in the high-risk population of NCDs between real food consumption and the CFP's recommendation (P < 0.05), such as the deficient intake of nuts and milk and dairy products, and the over-consumption of cereals, meat and poultry, oil, and salt. Participants with impaired fasting glucose had the highest intake of cereals and vegetables on average. Participants with central obesity were more likely to consume meat and poultry (P < 0.05). The lowest average intake of eggs and the highest average intake of milk and dairy products were found in participants with high blood cholesterol (P < 0.05). The daily smokers were more likely to consume beans and nuts (P < 0.05). The lowest average intake of fruits and the highest average intake of tubers were found in participants with high normal blood pressure (P < 0.05). Conclusion: Adherence to CFP in the high-risk population of NCDs appeared to be challenging. It is necessary to adopt dietary education campaign focusing on the high-risk population of NCDs to prevent or delay the occurrence of NCDs.

Maternal long working hours and offspring's weight-related outcomes: A systematic review and meta-analysis.

It is unclear whether maternal working time has an impact on offspring's weight-related outcomes especially obesity; the objective of this study is to conduct the first meta-analysis to focus on this topic. We searched PubMed, Ovid, and Web of Science databases through August 2021. A random-effect model was used to assess the pooled odds ratios (ORs) and regression coefficients (ß) with their corresponding 95% confidence intervals (95% CIs). Subgroup analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Egger's tests. Twenty-two observational studies were included with a total of 191,420 participants. Compared with children whose mothers worked less than 35 h/week, we found that children whose mothers worked more than 35 to 40 h/week had a 2.24-fold increased risk of childhood overweight/obesity (OR = 2.24, 95% CI: 1.61-3.11). An increment of 10 h/week in maternal working was associated with an approximately 1.0 percentage points in the probability of childhood overweight/obesity (ß = 0.008, 95% CI: 0.004-0.012). The pooled OR also indicated a similar result (OR = 1.09, 95% CI: 1.04-1.15). In addition, an increment of 10 h/week in maternal working was associated with 0.029 units increase in offspring's BMI z score (ß = 0.029, 95% CI: 0.016-0.042). Maternal long working hours is a potential risk factor for offspring's weight-related outcomes. Measures should be taken to protect the work welfare of females, thus facilitating the positive interaction of individual-family-society.

Waist circumference, waist-hip ratio, body fat rate, total body fat mass and risk of low back pain: a systematic review and meta-analysis.

PURPOSE: To identify the associations between waist circumference (WC), waist-hip ratio (WHR), body fat rate (BFR), total body fat mass (BFM), and the risk of low back pain (LBP). METHODS: We have searched PubMed through October 2020 for observational studies investigating the associations between WC, WHR, BFR, or total BFM and the risk of LBP. Random-effect models were used to calculate the summary risk estimates and corresponding 95% confidence intervals (95% CIs). RESULTS: A total of fifteen studies with 92,936 participants were included, of which ten were related to WC, five were related to WHR, four were related to BFR, and four were related to total BFM. Pooled results indicated that high WC (odds ratio (OR) = 1.30, 95% CI 1.10-1.54) and WHR (OR = 1.33, 95% CI 1.00-1.76) were associated with an increased risk of chronic low back pain (c-LBP). High WC (OR = 1.18, 95% CI 1.03-1.34) was also associated with an increased risk of non-c-LBP. The risk of non-c-LBP increased by 23% (OR = 1.23, 95% CI 1.01-1.50) for every 10% increase in BFR, and for every 10 kg increase in total BFM, the risk of non-c-LBP increased by 24% (OR = 1.24, 95% CI 1.10-1.39). CONCLUSION: Observational epidemiological evidence suggested that individuals with increased WC, WHR, BFR, or total BFM tended to have an increased risk of LBP, regardless of whether their body mass indexes were normal. Excessive fat mass was the essence of the process.

Prevalence and risk factors of hypertension among college freshmen in China.

Hypertension is the leading single contributor to all-cause death and disability worldwide. However, there is scarce evidence on the prevalence and risk factors of hypertension for Chinese youth. This study aimed to investigate the prevalence of hypertension among Chinese college freshmen and to identify the influencing factors. We conducted a cross-sectional study of all freshmen from 2015 to 2017 at a university in Wuhan, China by physical examination and standard-structured questionnaire. The Pearson chi-square test was used to compare categorical variables. Forward stepwise logistic regression method was used in the multivariate analysis to identify independent predictors of hypertension in youth. A total of 12,849 participants were included, and the prevalence of hypertension of Chinese college freshmen was 4.3% (7.9% in men and 1.6% in women). Men had a higher risk of hypertension than women (odds ratio [OR]: 5.358, 95% confidence interval [CI]: 4.345-6.607, P < 0.001). Obese people were more likely to develop hypertension than those with normal body mass index (OR: 10.465, 95% CI: 8.448-12.964, P < 0.001). People with elevated resting heart rate (RHR) had a higher prevalence of hypertension (OR: 4.987, 95% CI: 3.641-6.832, P < 0.001). Staying up late (OR: 2.957, 95% CI: 2.482-3.523, P < 0.001), physical inactivity (OR: 4.973, 95% CI: 4.141-5.972, P < 0.001), living in urban district (OR: 1.864, 95% CI: 1.493-2.329, P < 0.001) and family history of cardiovascular diseases (CVDs) (OR: 2.685, 95% CI: 2.108-3.421, P < 0.001) were related to higher prevalence of hypertension in youth. Male, obesity, elevated RHR, physical inactivity and family history of CVDs were identified as important risk factors of hypertension in youth. These risk factors should be given more attention when designing and implementing the interventional programs.

Efficacy and safety of bempedoic acid in patients with hypercholesterolemia: A systematic review and meta-analysis of randomized controlled trials.

AIM: Bempedoic acid is a novel oral drug, which has been increasingly researched to play an important role in the treatment of hypercholesterolemia recently. However, results from original studies were inconsistent and inconclusive. We aimed to conduct a meta-analysis to quantitatively appraise the efficacy and safety of bempedoic acid. METHODS: PubMed, Embase, Web of Science and Scopus were searched from inception to 30 January 2020. We included randomized controlled trials that compared the efficacy and safety of bempedoic acid with placebo in patients with hypercholesterolemia. Results from trials were presented as mean differences or odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled by random or fixed effects model. The risk of bias and heterogeneity among trials were also assessed and analyzed. RESULTS: Pooled analysis of 10 eligible trials showed that bempedoic acid treatment resulted in greater lowering of the low-density lipoprotein cholesterol level than the placebo group (mean difference -23.16%, 95% CI -26.92% to -19.04%). We also found that improvements in lipid parameters and biomarkers were still maintained at weeks 24 and 52 from the long-term trials. As for safety, bempedoic acid did not increase the risk of overall adverse events (OR 1.02, 95% CI 0.88 to 1.18). However, the incidence of adverse events leading to discontinuation was higher in the bempedoic acid group (OR 1.44, 95% CI 1.14 to 1.82). CONCLUSIONS: Available evidence from randomized controlled trials suggests that bempedoic acid provides a well-tolerated and effective therapeutic option for lipid lowering in patients with hyperlipidemia.