Hearing health survey of the population in Bangkok.

In this cross-sectional random survey among Thai adults living in Bangkok, we aimed to identify the prevalence of hearing problems and examine their relationship with individual factors. We administered a self-report questionnaire and performed pure-tone air conduction threshold audiometry. A total of 2463 participants (1728 female individuals) aged 15-96 years were included. The hearing loss prevalence was 53.02% and increased with age. The prevalence of a moderate or greater degree of hearing impairment was 2.8%. Participants aged 65 years and over had 8.56 and 6.79 times greater hearing loss and hearing impairment than younger participants, respectively. Male participants were twice as likely to have hearing loss and hearing impairment as female individuals. Participants with higher education levels showed less likelihood of having hearing loss and hearing impairment than those with no or a primary school education. Participants who ever worked under conditions with loud noise for > 8 h per day had 1.56 times greater hearing loss than those without such exposure. An inconsistent correlation was found between hearing loss, hearing impairment and noncommunicable diseases (diabetes, hypertension, and obesity). Although most participants had mild hearing loss, appropriate care and monitoring are necessary to prevent further loss in such individuals. The questionnaire-based survey found only people with hearing problems that affect daily communication.

Association of genetic variation on X chromosome with systemic lupus erythematosus in both Thai and Chinese populations.

OBJECTIVES: X chromosome has been considered as a risk factor for SLE, which is a prototype of autoimmune diseases with a significant sex difference (female:male ratio is around 9:1). Our study aimed at exploring the association of genetic variants in X chromosome and investigating the influence of trisomy X in the development of SLE. METHODS: X chromosome-wide association studies were conducted using data from both Thai (835 patients with SLE and 2995 controls) and Chinese populations (1604 patients with SLE and 3324 controls). Association analyses were performed separately in females and males, followed by a meta-analysis of the sex-specific results. In addition, the dosage of X chromosome in females with SLE were also examined. RESULTS: Our analyses replicated the association of TMEM187-IRAK1-MECP2, TLR7, PRPS2 and GPR173 loci with SLE. We also identified two loci suggestively associated with SLE. In addition, making use of the difference in linkage disequilibrium between Thai and Chinese populations, a synonymous variant in TMEM187 was prioritised as a likely causal variant. This variant located in an active enhancer of immune-related cells, with the risk allele associated with decreased expression level of TMEM187. More importantly, we identified trisomy X (47,XXX) in 5 of 2231 (0.22%) females with SLE. The frequency is significantly higher than that found in the female controls (0.08%; two-sided exact binomial test P=0.002). CONCLUSION: Our study confirmed previous SLE associations in X chromosome, and identified two loci suggestively associated with SLE. More importantly, our study indicated a higher risk of SLE for females with trisomy X.

Years of life lost and long-term outcomes due to glomerular disease in a Southeast Asian Cohort.

Death and end-stage kidney disease (ESKD) are major outcomes of glomerular disease. (GD) The years of potential life lost (YLL) may provide additional insight into the disease burden beyond death rates. There is limited data on premature mortality in GD. In this retrospective observational cohort study, we evaluated the mortality, ESKD rates, and YLL in Thais with biopsy-proven GD. The mortality and combined outcome rates were determined by log-rank test and ESKD by using a competing risk model. YLL and premature life lost before age 60 were calculated for different GD based on the life expectancy of the Thai population. Patients with GD (n = 949) were followed for 5237 patient years. The death rate and ESKD rates (95%CI) were 4.2 (3.7-4.9) and 3.3 (2.9-3.9) per 100 patient-years, respectively. Paraprotein-related kidney disease had the highest death rate, and diabetic nephropathy had the highest ESKD rate. Despite not having the highest death rate, lupus nephritis (LN) had the highest YLL (41% of all GD) and premature loss of life before age 60. In conclusion, YLL provided a different disease burden assessment compared to mortality rates and identified LN as the major cause of premature death due to GD in a Southeast Asian cohort.

Corrigendum: Severity of frailty using modified Thai Frailty Index, social factors, and prediction of mortality among community-dwelling older adults in a middle-income country.

[This corrects the article DOI: 10.3389/fmed.2022.1060990.].

Higher milk consumption is associated with a lower risk of diabetes mellitus: A case-control study.

BACKGROUND & AIMS: Studies have determined that people with genetically defined lactase non-persistence have lower dairy intake that may lead to an increase risk of various non-communicable diseases. Furthermore, lactase non-persistence itself has been associated with insulin resistance. However, data on lactase non-persistence status and dairy intake in developing countries are sparse. We therefore aimed to define 1) the prevalence of lactase non-persistence among individuals with diabetes and non-diabetes in Thai population and 2) the links between lactase non-persistence, milk consumption, and risk of diabetes mellitus. METHODS: We conducted a case-control study from participants of the National Health Examination Survey. DNA was isolated from the blood for LCT -13910C>T (rs4988235) polymorphism and processed using the Bio-rad c1000 touch thermal cycler and MALDI-TOF Mass Spectrometry MassARRAY Typer v4.0 (Agena Bioscience, San Diego, CA, USA) at the Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital. Cases were participants with previously diagnosed diabetes mellitus or fasting plasma glucose ≥126 mg/dL (n = 1,756) vs. the controls (n = 2,380). RESULTS: We included 4,136 participants, 62% female, and 98.8% were > 30 years old. Homozygous CC genotype (i.e., lactase non-persistence) was noted in 98.6% and only 1.4% carried heterozygous CT. Most (76%) consumed milk <1 portion/month. Participants with either CC or CT genotype had comparable milk consumption and the risk of diabetes mellitus. Males, older adults, and lower education had a lower chance of consuming milk at least one portion per month. Besides various baseline variables, we found that higher milk consumption was associated with a lower DM risk (P = .01). CONCLUSION: The prevalence of lactase non-persistence in Thai population is very high. A significant difference in milk consumption frequency in relation to the lactase non-persistence status was not found. However, higher milk consumption is associated with a lower risk of diabetes mellitus.

Update on vitamin D status in sunshine-abundant Thailand, 2019-2020.

OBJECTIVE: The prevalence of vitamin D deficiency worldwide remains unknown. In the Thai 4th National Health Examination Survey (2008-2009) cohort, ∼45% and 7% of the adult population had serum 25-hydroxyvitamin-D [25(OH)D] levels below the threshold of 75 and 50 nmol/L, respectively. Vitamin D has been a hot topic in the scientific community. The aim of this study was to uncover the current situation regarding vitamin D status in Thailand. METHODS: Participants were 4098 adults ages 10 to 96 y, randomly selected from the Thai 6th National Health Examination Survey (2019-2020) cohort. Serum 25(OH)D levels were measured by liquid chromatography/tandem mass spectrometry. Data were expressed as mean ± SE and adjusted odds ratio (95% CI). RESULTS: Mean vitamin D status based on serum 25(OH)D was 88.2 nmol/L and differed by age, sex, residency, and religion. The prevalence of serum 25(OH)D <75 and <50 nmol/L were 31% and 4%, respectively. The prevalence of vitamin D deficiency was lower in individuals who lived in the northeastern part of Thailand or were male. The risk for vitamin D deficiency was lower than that in 2009. In multiple linear regression analysis, female sex, younger age, urbanization, a higher body mass index, Muslim religion, and living in Bangkok or the central region of Thailand were independently associated with lower serum 25(OH)D levels. CONCLUSIONS: The vitamin D status in the Thai population has improved over the past 10 y. This improvement may reflect an increased awareness related to adequate vitamin D status.

Association between socioecological factors and electronic cigarette use among Thai youth: an institution-based cross-sectional study.

OBJECTIVES: This study aimed to examine cigarette use distribution, pattern of e-cigarette use and to determine socioecological model (SEM) factors associated with e-cigarette use among Thai youth (aged 15-24). DESIGN: An institution-based cross-sectional study. PARTICIPANTS: The study conducted in five regions: the north, south, central, northeast and Bangkok area of Thailand from May to October 2021. An internet-based, self-administered questionnaire was developed based on the SEM. We enrolled 13 139 students who understood Thai and voluntarily consented to participate in the study. Hierarchical generalised estimating equations identified the related factors to e-cigarette use consistent with the SEM. RESULTS: Of 12 948 respondents (95.5%), 181 were excluded due to a lack of cigarette use status. Of 12 767, the prevalence of cigarette use was 4.3%, e-cigarette use was 3.5% and dual-use was 2.4%. E-cigarettes were a much more favourable choice among female youth than cigarettes. E-cigarette users tended to express more positive beliefs towards e-cigarettes than non-users. Although the use of e-cigarettes is illegal in Thailand, 66% of users obtained e-cigarettes from online markets and 4% from grocery stores. We found that having a girlfriend or boyfriend who uses e-cigarettes increased the odds of e-cigarette use by 3.239 times. Interestingly, higher odds of e-cigarette use were associated with peer use than with sibling use among e-cigarette users. (Adjusted OR 2.786, 95% CI 1.844 to 4.208 and 2.485, 95% CI 1.402 to 4.404, respectively). Exposure to e-cigarette use in school increased the odds of e-cigarette use by four times. CONCLUSION: This institution-based cross-sectional study revealed that youth e-cigarette use is a significant problem. To prevent the increasing rate of e-cigarette use, health literacy about e-cigarette use, including media and information literacy, should be launched across all levels of the school environment to enlist youth to stand against the negative impacts of e-cigarette use among all those of school age.

The Association of Sociodemographic Variables and Unhealthy Behaviors With Limitations in Activities of Daily Living Among Thai Older Adults: Cross-sectional Study and Projected Trends Over the Next 20 Years.

BACKGROUND: Extended life spans have led to an increase in the number of older people and an increase in the prevalence of disability among people older than 60 years of age. OBJECTIVE: This study aims to investigate the association of sociodemographic variables and unhealthy behaviors with limitations in activities of daily living (ADL) among Thai older adults. The study also projects the number of older individuals likely to experience ADL limitations in the next 20 years. METHODS: We performed sex-specific multinomial logistic regression analysis based on the 5th Thai National Health Examination Survey in 2014 to investigate the association between sociodemographic variables and health behaviors with ADL limitations among Thai older adults. Age- and sex-specific prevalence estimates of ADL limitations were obtained by applying the same models. These estimates were combined with population projections up to 2040 from the Office of the National Economic and Social Development Board, Thailand, to generate projections of older individuals with ADL limitations. RESULTS: Age and physical activity were significant factors for both sexes, with age positively associated with the level of ADL limitations and low physical activity associated with an increased relative probability of mild or moderate to severe ADL limitations compared to individuals with no ADL limitation (1.2-2.2 times). Other variables such as education, marital status, diabetes, hypertension, smoking, alcohol consumption, and having a fruit- and vegetable-based diet showed significant associations, but the results varied regarding sex and levels of ADL limitations. This study also projected the number of older adults with mild and moderate to severe ADL limitations over the next 20 years from 2020 to 2040, revealing an increase of 3.2 and 3.1 times, respectively, along with a significant increase in men compared to that in women. CONCLUSIONS: This study identified age and physical activity as significant factors associated with ADL limitations in older adults, while other factors showed varying associations. Over the next 2 decades, projections suggest a significant increase in the number of older adults with ADL limitations, particularly men. Our findings emphasize the importance of interventions to reduce ADL limitations, and health care providers should consider various factors impacting them.

Intestinal helminth infections and associated risk factors among adults in the Lao People's Democratic Republic.

BACKGROUND: Helminthiases are highly endemic in Southeast Asia, including the Lao People's Democratic Republic (Lao PDR). This study aimed to assess the current intestinal helminth infections and the associated risk factors among adults across the Lao PDR. METHODS: A cross-sectional survey was conducted in 165 villages across 17 provinces and the Vientiane Capital, Lao PDR. A multi-stage sampling method was employed to select the adult study participants (≥ 18 years). Data collection included (1) interview of the study participants, (2) physical measurements, and (3) a five gram of stool sample from each study participant was collected and preserved in 10% formalin solution for intestinal helminth detection using formalin-ether concentration technique (FECT). Descriptive analysis was used to describe the socio-demographic characteristics of study participants and the prevalence of intestinal helminth infections. Logistic regressions were applied to test the association between intestinal helminth infection and individual risk factors. A P-value below 0.05 was considered statistically significant. RESULTS: A total of 2800 study participants were enrolled. Their average age was 46.0 years; 57.8% were female. Overall, 30.9%, 8.6% and 1.5% of study participants were infected with one, two, or three different intestinal helminth species, respectively. Among the study participants 21.6% were infected with hookworm, 18.8% with Opisthorchis viverrini-like (Ov-like) infection, 4.8% with Strongyloides stercoralis, 2.3% with Ascaris lumbricoides, 1.5% with Trichuris trichiura, and 3.3% with Taenia spp. Ov-like infection was of high prevalence in the southern (28.8%) and central (21.3%) provinces, while hookworm (26.3%), A. lumbricoides (7.3%), T. trichiura (3.1%), and Taenia spp. (4.2%) were prevalent in the northern provinces. Risk analysis showed that men were more likely to be infected with hookworm [adjusted odds ratio (aOR) = 1.2, P = 0.019]. The Lao-Tai ethnic group had a 5.2-times (P < 0.001) higher chance of having Ov-like infection than the minorities. Possession of toilet facility at home was associated with reduced odds for Ov-like (aOR = 0.4, P < 0.001) and hookworm (aOR = 0.6, P < 0.001) infections. CONCLUSIONS: Our study provides a nationwide update of the intestinal helminth prevalence among adults in Lao PDR. To the best of our knowledge, this is the first Lao nationwide survey on intestinal helminth infections and risk factors in adults. It provides crucial information for national control programs for intestinal helminth infections in Lao PDR.

Dietary diversity predicts the mortality among older people: Data from the fifth Thai national health examination survey.

OBJECTIVE: To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association. METHODS: The national survey conducted from 2013 to 2015 recruited 5631 people aged >60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested. RESULTS: The DDS was inversely associated with mortality (HRadj 0.98, 95%CI: 0.96-1.00). This association was stronger in people aged >70 years (HRadj 0.93, 95%CI: 0.90-0.96 for aged 70-79 years, and HRadj 0.92, 95%CI: 0.88-0.95 for aged >80 years). Inverse association between DDS and mortality was also found in the underweight older population (HRadj 0.95, 95%CI: 0.90-0.99). A positive association was found between DDS and mortality in the overweight/obese group (HRadj 1.03, 95%CI: 1.00-1.05). However, the interaction between the DDS with sex to mortality was not statistically significant. CONCLUSION: Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.

Ideal cardiovascular health and all-cause or cardiovascular mortality in a longitudinal study of the Thai National Health Examination Survey IV and V.

The relationship of ideal cardiovascular health (CVH) and health outcomes has been rarely assessed in middle-income countries. We determined the ideal CVH metrics and association with all-cause and cardiovascular (CVD) mortality in the Thai population. We used baseline data from two rounds of the National Health Examination survey (15,219 participants in 2009 and 14,499 in 2014), and assessed all-cause and CVD deaths until 2020. The prevalence of 5-7 ideal CVH metrics in 2009 was 10.4% versus 9.5% in 2014. During a median follow-up of 7.1 years, the all-cause and CVD mortality rates were 19.4 and 4.6 per 1000 person-years for 0-1 ideal CVH metrics, and 13.0 and 2.1, 9.6 and 1.5, 6.0 and 1.0, and 2.9 and 0.4 per 1000 person-years for 2, 3, 4, and 5-7 ideal CVH metrics, respectively. Participants with 2, 3, 4, or 5-7 ideal metrics had a significantly lower risk of mortality than those with 0-1 ideal CVH metrics (adjusted hazard ratios: 0.75, 0.70, 0.60, and 0.47 for all-cause, and 0.54, 0.52, 0.50, and 0.31 for CVD, respectively). Individuals with a higher number of the modified ideal CVH metrics have a lower risk of all-cause and CVD mortality.

Stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among general adult population: the results from the 6th Thai National Health Examination Survey (NHES VI).

Background: Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors. Methods: This study was based on data from the 6th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years. Results: We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19). Conclusions: We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained.

Severity of frailty using modified Thai frailty index, social factors, and prediction of mortality among community-dwelling older adults in a middle-income country.

Background: Frailty has been increasingly recognized as a public health problem for aging populations with significant social impact, particularly in low- and middle-income countries. We aimed to develop a modified version of the Thai Frailty Index (TFI) and explore the association between different frailty statuses, socioeconomic factors, and mortality in community-dwelling older people from a middle-income country. Methods: The data from participants aged ≥60 years in the Fourth Thai National Health Examination Survey were used to construct the 30-item TFI. Cutoff points were created based on stratum-specific likelihood ratio. TFI ≤ 0.10 was categorized as fit, 0.10-0.25 as pre-frail, 0.25-0.45 as mildly frail, and >0.45 as severely frail. The association of frailty status with mortality was examined using Cox proportional hazard models. Findings: Among 8,195 older adults with a mean age of 69.2 years, 1,284 died during the 7-year follow-up. The prevalence of frailty was 16.6%. The adjusted hazard ratio (aHR) for mortality in pre-frail was 1.76 (95% CI = 1.50-2.07), mildly frail 2.79 (95% CI = 2.33-3.35), and severely frail 6.34 (95% CI = 4.60-8.73). Having a caretaker in the same household alleviated mortality risk for severely frail participants with an aHR of 2.93 (95% CI = 1.92-4.46) compared with an aHR of 6.89 (95% CI = 3.87-12.26) among those living without a caretaker. Interpretation: The severity of frailty classified by the modified TFI can predict long-term mortality risk for community-dwelling older adults. Identification of severely frail older people to provide appropriate care might alleviate mortality risk. Our findings can inform policymakers to appropriately allocate services in a resource-limited setting.

Association between electronic cigarette use and depression among Thai adolescents: The Thailand National Health Examination Survey 2019-2020.

INTRODUCTION: Depression and e-cigarette use among adolescents are two health burdens. However, the association between these dual problems have been less studied, especially in low- and middle-income countries. This study examined the association between depression and e-cigarette use among adolescents in Thailand. METHODS: This cross-sectional study used the sub-sample of the sixth Thai National Health Examination Survey conducted between 2019 and 2020. A total of 4237 adolescents aged 10-19 years were included. Self-reported depression was captured using the 20-item Centre for Epidemiologic Studies Depression Scale (CES-D). We applied a complex survey multiple logistic regression to assess whether e-cigarette use was associated with depression. RESULTS: The mean age of the participants was 14.6 years, 5.3% were ever e-cigarette users, and 2.9% were current e-cigarette users. 37.8% of the participants were categorized at risk for depression. Among e-cigarette users, 51.6% of ever e-cigarette users and 52.9% of current e-cigarette users were at risk for depression. Multiple logistic regression revealed that ever e-cigarette users were at higher risk for depression (AOR=1.66; 95% CI: 1.02-2.71; p=0.042) than never e-cigarette users. Current e-cigarette was not associated with a higher risk for depression (AOR=1.37; 95% CI: 0.77-2.45; p=0.263). CONCLUSIONS: E-cigarette use and depression among adolescents are global public health concerns. There is also a need for effective screening, prevention, and intervention to reduce adverse outcomes of e-cigarette use and depression. In addition, the government should strengthen current policies and close legal loopholes to prevent the tobacco industry tactics and keep e-cigarettes away from adolescents.

Sleep duration and risk of high blood pressure in Thai adolescents: the Thai National Health Examination Survey V, 2014 (NHES-V).

BACKGROUND: Sleep duration has been proposed to be associated with high blood pressure. However, nationwide studies regarding this association in adolescents remain limited. This study aimed to explore the national prevalence of high blood pressure among Thai adolescents and to determine the association between sleep duration and high blood pressure. METHODS: Data from adolescents aged 10-19 years from the Thai National Health and Examination Survey V were included. We collected demographic data (including age and gender), height, weight, waist circumference, blood pressure, fasting blood chemistries and sleep duration data. Sleep durations were categorized as short, normal or long for each age group based on the United States National Sleep Foundation's recommendations. High blood pressure was diagnosed using the 2017 guidelines of the American Academy of Pediatrics. Factors associated with high blood pressure were analyzed using multivariate logistic regression. RESULTS: A total of 3505 adolescents (1785 female) were included. The prevalence of high blood pressure was 9.4% (95% CI 8.5-10.4%). The high blood pressure group had higher BMI z-score, LDL-C, triglyceride and lower HDL-C than the normotensive group. In the multivariate analysis, BMI z-score, LDL-C and HDL-C were independently associated with high blood pressure. However, there was no association between sleep duration and high blood pressure. CONCLUSIONS: High blood pressure risk was increased in adolescents with high BMI z-score. Neither short nor long sleep duration was associated with an increased risk of high blood pressure.

Dietary diversity associated with risk of cardiovascular diseases among community-dwelling older people: A national health examination survey from Thailand.

Background: Cardiovascular diseases (CVD) are the common comorbidities in older people. Healthy diet is an essential strategy to alleviate the risk of developing CVD. Dietary diversity (DD) is an indicator of diet quality. Currently, limited research exists regarding DD and CVD in older people in developing countries, such as Thailand, despite rapid growth of older population. Therefore, this study aims to determine associations of DD with the risk of CVD and the cardiometabolic risk factors among Thai older people. Methods: This cross-sectional study used the sub-sample of the fifth Thai National Health Examination Survey conducted from 2013 to 2015. A total of 6,956 older people aged 60 years and older and no pre-existing CVD were included.Dietary diversity score (DDS) was assessed the consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4. The DDS was calculated as the sum of the scores (0-32). The risk of CVD was calculated by using a Thai cardiovascular (CV) risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Data were adjusted for a complex survey design and analysed using linear and logistic regression models. Results: In the adjusted model, DDS had a significant negative association with log-Thai CV risk score, with adjusted ß (95% CI) values of -0.01 (-0.01, -0.01). Regarding the cardiometabolic risk factors, DDS had a significant negative association with hypertension, DM and log-TG levels, with adjusted OR (95% CI) values of 0.97 (95% CI 0.97, 0.98) for hypertension, 0.94 (0.93, 0.95) for DM, and adjusted ß (95% CI) values of -0.002 (-0.004, -0.001) for log-TG level. DDS was positively associated with TC and LDL-C, with adjusted ß (95% CI) values of 0.59 (0.38, 0.80) for TC and 0.59 (0.38, 0.79) for LDL-C levels, while DDS was not associated with HDL-C level. Conclusion: Higher DD was associated with a lower risk of CVD among Thai older people. The nutritional policies or interventions should encourage a diverse food intake for the prevention of CVD in this population.

Mendelian randomization study of the effect of coronary artery calcification on atherosclerotic cardiovascular diseases.

Calcium calcification in the wall of arteries (CAC) leads to a higher risk of atherosclerosis related outcomes, especially myocardial infarction (MI). Nevertheless, the causal role of CAC on other related outcomes is unclear. In this study, we used Mendelian randomization (MR) to systematically investigate the causal role of CAC across a broad range of atherosclerotic cardiovascular diseases including coronary heart disease, angina, MI, ischemic heart disease, stroke, and peripheral vascular disease. Publicly available data from the UK biobank and other data sources were used. Using the two-sample Mendelian randomization (MR) approach, we applied 3 MR models including the inverse variance weighted, the weighted-median, and the weighted-mode methods. Eight SNPs associated with CAC were selected as instrumental variables. We observed causal evidence of CAC on MI consistently across all MR models (PIVW = 1.0 × 10-4, PW-Median = 1.1 × 10-4, PW-Mode = 3.8 × 10-2) and this causation is shown in an acute transmural MI of inferior wall (PIVW = 1.5 × 10-4, PW-Median = 4.8 × 10-5, PW-Mode = 3.2 × 10-2) but not consistently observed in an anterior wall. As each site of acute MI was suggested to have relatively specific mechanisms, our finding suggested that the causal role of CAC on MI is in an inferior wall possibly as a consequence of large calcification from a prolonged process, whereas non-calcified artery plaque or other underlying mechanisms may predominantly play role in an anterior infarction during an advanced atherosclerotic process.

Muscle strength, but not body mass index, is associated with mortality in patients with non-alcoholic fatty liver disease.

BACKGROUND: Whether adiposity and muscle function are associated with mortality risk in patients with non-alcoholic fatty liver disease (NAFLD) remains unknown. We examine the independent and combined associations of body mass index (BMI) and muscle strength with overall mortality in individuals with NAFLD. METHODS: We analysed data from 7083 participants with NAFLD in the Thai National Health Examination Survey and their linked mortality. NAFLD was defined using a lipid accumulation product in participants without significant alcohol intake. Poor muscle strength was defined by handgrip strength of <28 kg for men and <18 kg for women, according to the Asian Working Group on Sarcopenia. The Cox proportional-hazards model was constructed to estimate the adjusted hazard ratio (aHR) for overall mortality. RESULTS: The mean age was 49.3 ± 13.2 years, and 69.4% of subjects were women. According to the Asian-specific criteria, 1276 individuals (18.0%) were classified as lean NAFLD (BMI 18.5-22.9 kg/m2 ), 1465 (20.7%) were overweight NAFLD (BMI 23-24.9 kg/m2 ), and 4342 (61.3%) were obese NAFLD (BMI ≥ 25 kg/m2 ). Over 60 432 person-years, 843 participants died. In Cox models adjusted for physiologic, lifestyle, and comorbid factors, individuals with lean NAFLD [aHR 1.18, 95% confidence interval (CI): 0.95-1.48; P = 0.138] and subjects with overweight NAFLD (aHR 1.28, 95% CI: 0.89-1.84; P = 0.158) had mortality risk estimates similar to their obese counterparts, whereas participants with lower handgrip strength had significantly higher mortality risk than those with higher handgrip strength in men and women. Compared with obese individuals with the highest handgrip strength, elevated mortality risk was observed among men (aHR 3.21, 95% CI: 1.35-7.62, P = 0.011) and women (aHR 2.22, 95% CI, 1.25-3.93, P = 0.009) with poor muscle strength. Among men, poor muscle strength was associated with increased risk of mortality with obese NAFLD (aHR 3.94, 95% CI, 1.38-11.3, P = 0.013), overweight NAFLD (aHR 2.93, 95% CI, 1.19-7.19, P = 0.021), and lean NAFLD (aHR 2.78, 95% CI, 0.93-8.32, P = 0.065). Among women, poor muscle strength was associated with increased mortality risk with obese NAFLD (aHR 2.25, 95% CI, 1.06-4.76, P = 0.036), overweight NAFLD (aHR 1.69, 95% CI, 0.81-3.51, P = 0.153), and lean NAFLD (aHR 2.47, 95% CI, 1.06-5.73, P = 0.037). CONCLUSIONS: In this nationwide cohort of individuals with NAFLD, muscle strength, but not BMI, was independently associated with long-term overall mortality. Measuring handgrip strength can be a simple, non-invasive risk stratification approach for overall mortality in patients with NAFLD.

Body Mass Index Combined With Possible Sarcopenia Status Is Better Than BMI or Possible Sarcopenia Status Alone for Predicting All-Cause Mortality Among Asian Community-Dwelling Older Adults.

Background: Body mass index (BMI) and sarcopenia are common indicators of nutritional status. Possible sarcopenia, defined as low muscle strength or performance, was recently introduced by the Asian Working Group for Sarcopenia (AWGS) in 2019. We investigated for association between all-cause mortality and BMI combined with possible sarcopenia severity in Asian older adults. Methods: This study included a subpopulation (8,195 participants aged ≥60 years; male gender: 49.4%; mean age: 69.2 ± 6.8 years) from the Fourth Thai National Health Examination Survey (NHES-IV). BMI was classified using Asia-Pacific cut-offs. Possible sarcopenia was defined using quadriceps strength based on AWGS 2019 criteria, and possible sarcopenia severity was determined using study population quartile cut-offs. All-cause mortality data was derived from the national vital registry in 2020. Results: The prevalence of underweight status and possible sarcopenia was 11.8 and 38.9%, respectively. Multivariate analysis showed underweight individuals with severe possible sarcopenia to be at highest risk for increased mortality [adjusted hazard ratio (aHR): 3.98, 95% confidence interval (CI): 2.89-5.48], and higher risk was found in men compared to women (aHR: 5.35, 95% CI: 1.19-8.97). Obese status without possible sarcopenia was an independent protective factor (aHR: 0.61, 95% CI: 0.38-0.97). Conclusion: BMI combined with possible sarcopenia severity is a better predictor of mortality risk than either parameter alone.