Associations of Combined Exposure to Metabolic and Inflammatory Indicators with Thyroid Nodules in Adults: A Nested Case-Control Study.

Objective: To explore associations of combined exposure to metabolic/inflammatory indicators with thyroid nodules. Methods: We reviewed personal data for health screenings from 2020 to 2021. A propensity score matching method was used to match 931 adults recently diagnosed with thyroid nodules in a 1 : 4 ratio based on age and gender. Conditional logistic regression and Bayesian kernel machine regression (BKMR) were used to explore the associations of single metabolic/inflammatory indicators and the mixture with thyroid nodules, respectively. Results: In the adjusted models, five indicators (ORQ4 vs. Q1: 1.30, 95% CI: 1.07-1.58 for fasting blood glucose; ORQ4 vs. Q1: 1.30, 95% CI: 1.08-1.57 for systolic blood pressure; ORQ4 vs. Q1: 1.26, 95% CI: 1.04-1.53 for diastolic blood pressure; ORQ4 vs. Q1: 1.23, 95% CI: 1.02-1.48 for white blood cell; ORQ4 vs. Q1: 1.28, 95% CI: 1.07-1.55 for neutrophil) were positively associated with the risk of thyroid nodules, while high-density lipoproteins (ORQ3 vs. Q1: 0.75, 95% CI: 0.61-0.91) were negatively associated with the risk of thyroid nodules. Univariate exposure-response functions from BKMR models showed similar results. Moreover, the metabolic and inflammatory mixture exhibited a significant positive association with thyroid nodules in a dose-response pattern, with systolic blood pressure being the greatest contributor within the mixture (conditional posterior inclusion probability of 0.82). No interaction effects were found among the five indicators. These associations were more prominent in males, participants with higher age (≥40 years old), and individuals with abnormal body mass index status. Conclusions: Levels of the metabolic and inflammatory mixture have a linear dose-response relationship with the risk of developing thyroid nodules, with systolic blood pressure levels being the most important contributor.

Short-term effects of heatwaves on clinical and subclinical cardiovascular indicators in Chinese adults: A distributed lag analysis.

AIMS: Previous studies have related heat waves to morbidity and mortality of cardiovascular diseases; however, potential mechanisms remained limited. Our aims were to investigate the short-term effects of heat waves on a series of clinical/subclinical indicators associated with cardiovascular health. METHODS: Our study used 80,574 health examination records from the Health Management Center of Nanjing Zhongda Hospital during the warm seasons of 2019-2021, including 62,128 participants. A total of 11 recognized indicators of cardiovascular risk or injury were assessed. Air pollution and meteorological data were obtained from the Nanjing Ecological Environment Bureau and the China Meteorological Data Network, respectively. Heat waves were defined as a daily average temperature over the 95th percentile for three or more consecutive days from May to September. We used a combination of linear mixed effects models and distributed lag nonlinear models to assess the lagged effects of heat waves on clinical and subclinical cardiovascular indicators. Stratified analyses based on individuals' characteristics, including gender, age, body mass index (BMI), diabetes, and hypertension, were also performed. RESULTS: Heat waves were related to significant changes in most indicators, with the magnitude of effects generally peaking at a lag of 0 to 3 days. Moreover, the cumulative percentage changes over lag 0-7 days were -0.82 % to -2.55 % in blood pressure, 1.32 % in heart rate, 0.20 % to 2.66 % in systemic inflammation markers, 0.36 % in a blood viscosity parameter, 9.36 % in homocysteine, and 1.35 % to 3.25 % in injuring myocardial enzymes. Interestingly, females and males showed distinct susceptibilities in different indicators. Stronger effects were also found in participants aged 50 years or over, individuals with abnormal BMI status, and patients with diabetes. CONCLUSION: Short-term exposure to heat waves could significantly alter clinical/subclinical cardiovascular indicator profiles, including blood pressure changes, increased heart rate, acute systemic inflammation, elevated blood viscosity, and myocardial injury.

Short-term effects of ambient PM1, PM2.5, and PM10 on internal metal/metalloid profiles in older adults: A distributed lag analysis in China.

There is limited evidence linking exposure to ambient particulate matter (PM) with internal doses of metals and metalloids (metal(loid)s). This study aimed to evaluate the effects of short-term exposure to ambient PM on urine metal(loid)s among Chinese older adults. Biological monitoring data of 15 urine metal(loid)s collected in 3, 970 community-dwelling older adults in Fuyang city, Anhui Province, China, from July to September 2018, were utilized. PMs with an aerodynamic diameter ≤ 1 µm (PM1), ≤ 2.5 µm (PM2.5), and ≤ 10 µm (PM10) up to eight days before urine collection were estimated by space-time extremely randomized trees (STET) model. Residential greenness was reflected by Normalized Difference Vegetation Index (NDVI). We used generalized additive model (GAM) combined with distributed lag linear/non-linear models (DLMs/DLNMs) to estimate the associations between short-term PM exposure and urine metal(loid)s. The results suggested that the cumulative exposures to PM1, PM2.5, or PM10 over two days (lag0-1 days) before urine collection were associated with elevated urine metal(loid)s in DLMs, while exhibited linear or "inverted U-shaped" relationships with seven urine metal(loid)s in DLNMs, including Gallium (Ga), Arsenic (As), Aluminum (Al), Magnesium (Mg), Calcium (Ca), Uranium (U), and Barium (Ba). Aforementioned results indicated robust rather than spurious associations between PMs and these seven metal(loid)s. After standardizations for three PMs, PM1 was the greatest contributor to U, PM2.5 made the greatest contributions to Ga, As, Al, and Ba, and PM10 contributed the most to Mg and Ca. Furthermore, the effects of three PMs on urine Ga, As, Al, Mg, Ca, and Ba were reduced when exposed to higher levels of NDVI. Overall, short-term exposures to ambient PMs contribute to elevated urinary metal(loid) levels in older adults, and three PMs exhibit various contributions to different urine metal(loid)s. Moreover, residential greenness may attenuate the effects of PMs on urine metal(loid)s.

Short-term effects of cold spells on hematocrit among adults in Nanjing, China: A distributed-lagged effect analysis.

BACKGROUND: Previous studies have linked exposure to cold spells with cardiovascular diseases, however, underlying mechanisms remained to be understood. We aimed to explore the short-term effects of cold spells on hematocrit, a blood indicator associated with cardiovascular disease. METHODS: Our study was performed among 50,538 participants (68,361 health examination records) who visited the health examination centers of Zhongda Hospital in Nanjing City, China, during the cold seasons from 2019 to 2021. Data on meteorology and air pollution were obtained from the China Meteorological Data Network and the Nanjing Ecological Environment Bureau, respectively. Cold spells in this study were defined as daily mean temperatures (Tmean) <3rd or 5th percentile with two or more consecutive days. Linear mixed-effect models combined with distributed lag nonlinear models were applied to estimate associations of cold spells with hematocrit. RESULTS: Cold spells were found to be significantly correlated with increased hematocrit on lag 0 to 26 days. Moreover, the cumulative effects of cold spells on hematocrit remained significant at varying lag days. These single and cumulative effects were robust across different definitions of cold spells and conversions of hematocrit. For instance, cold spells (Tmean <3rd percentile) at lags 0, 0-1, and 0-27 days were significantly associated with 0.09 [95 % confidence interval (CI): 0.03, 0.15], 0.17 (95 % CI: 0.07, 0.28), and 3.71 (95 % CI: 3.06, 4.35) - unit (%) increases in original hematocrit, respectively. In subgroup analyses, stronger effects of cold spells on hematocrit were observed in females and participants aged 50 years or over. CONCLUSION: Cold spells have significant immediate and longer-lagged effects (up to 26 days) on hematocrit. Females and individuals aged 50 years or over are more sensitive to cold spells. These findings might provide a new perspective for exploring the effects of cold spells on adverse cardiac events.

Selenium attenuates the association of co-exposure to arsenic, cadmium, and lead with cognitive function among Chinese community-dwelling older adults.

The effects of interactions between the toxic and essential metal mixtures on cognitive function are poorly understood. This study aims to identify the joint association of arsenic (As), cadmium (Cd), and lead (Pb) with cognitive function in older adults and the moderating role of selenium (Se), zinc (Zn), and copper (Cu) in this association. This study included 1000 community-dwelling older adults. Cognitive function was assessed by the Mini-Mental State Examination (MMSE). Blood concentrations of As, Cd, Pb, Se, Zn, and Cu were measured using inductively coupled plasma mass spectrometry. Linear regression and Bayesian kernel machine regression (BKMR) models were applied to assess the individual and joint associations of As, Cd, and Pb with cognitive function and to examine whether Se, Zn, and Cu (individually and as a mixture) modified these associations. In the adjusted single-metal models, both Cd (ß = - 0.37, 95% CI: - 0.73 to - 0.01) and Pb (ß = - 0.44, 95% CI: - 0.86 to - 0.02) were associated with MMSE scores, while Se (ß = 0.71, 95% CI: 0.30 to 1.13) exhibited a positive relationship with MMSE scores. Univariate exposure-response functions from BKMR models showed similar results. Moreover, the toxic metal mixture (As, Cd, and Pb) exhibited a significant negative association with MMSE scores in a dose-response pattern, with Pb being the greatest contributor within the mixture. The negative association of Pb alone or the toxic metal mixture with MMSE scores became weaker at higher concentrations of Se within its normal range, especially when Se levels were greater than the median (89.18 µg/L). Our findings support that Se can attenuate the negative associations of exposure to single Pb or the As, Cd, and Pb mixtures with cognitive function. Future prospective studies are needed to replicate our findings.

Gender-and age-specific associations of sleep duration and quality with cognitive impairment in community-dwelling older adults in Anhui Province, China.

Objective: To examine associations of sleep duration and quality with cognitive impairment in older adults and the moderating role of gender and age in these associations. Methods: This community-based cross-sectional study included 4,837 participants aged 60 years and above. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE), and the participants were grouped based on the presence of cognitive impairment. The duration and quality of sleep were assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression models were used to analyze associations of sleep duration and quality with cognitive impairment. The role of age and gender in these associations have also been explored. Results: The age (mean ± SD) of the participants was 71.13 ± 5.50 years. Of all older adults, 1,811 (37.44%) were detected as cognitive impairment, and 1755 (36.8%) had poor sleep quality. Among those with cognitive impairment, 51.09% were female. The proportion of the participants with cognitive impairment is significantly higher in those with symptoms of depression (49.73%, 273/549) (χ2 = 41.275, p < 0.001) than in those without depressive symptoms. After adjustment for multiple confounding factors and the crucial covariate (depressive symptoms), the odds ratios (OR) (95% confidence interval [CI]) of cognitive impairment (with 7-7.9 h regarded as the reference group) for individuals with a sleep duration of <6, 6-6.9, 8-8.9, and ≥ 9 h were 1.280 (1.053-1.557), 1.425 (1.175-1.728), 1.294 (1.068-1.566), and 1.360 (1.109-1.668), respectively. Subgroup analysis showed a V-shaped association between night sleep duration and cognitive impairment in males (p ≤ 0.05), and the association was stronger for individuals aged 60-80 years. With regard to sleep quality, the fully adjusted OR (95%CI) of cognitive impairment were 1.263 (1.108-1.440). According to scores of subscales in the PSQI, daytime dysfunction was associated with an increased risk of cognitive impairment (OR: 1.128, 95%CI: 1.055-1.207). Subgroup analysis also revealed a statistically significant correlation between poor sleep quality (including daytime dysfunction) and cognitive impairment in different gender and age groups, with the association being stronger in females (OR: 1.287, 95%CI: 1.080-1.534) and those aged 81-97 years (OR: 2.128, 95%CI: 1.152-3.934). For cognitive impairment, the group aged 81-97 years with daytime dysfunction was associated with a higher odds ratio than other age groups. Conclusion: The present study showed that inadequate or excessive sleep was associated with cognitive impairment, especially in males, who exhibited a V-shaped association. Cognitive impairment was also associated with poor sleep quality as well as daytime dysfunction, with females and individuals aged 81-97 years exhibiting the strongest association.

The association between essential trace element mixture and atherosclerotic cardiovascular disease risk among Chinese community-dwelling older adults.

The evidence about the association of the essential trace element (ETE) mixture with atherosclerotic cardiovascular disease (ASCVD) amongst older adults is limited. This study aims to evaluate the associations of single ETEs and the ETE mixture with the 10-year ASCVD risks and its predicting factors in Chinese community-dwelling older adults. A total of 607 community-dwelling older adults were included in this study. Blood levels of vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), and selenium (Se) were assessed by inductively coupled plasma mass spectrometry. The predicted 10-year ASCVD risk was calculated using the Prediction for ASCVD Risk in China (China-PAR) equations. Traditional linear regressions and Bayesian kernel machine regression (BKMR) were used to assess the associations of single ETEs and the ETE mixture with the 10-year ASCVD risks and its predicting factors such as systolic blood pressure (SBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), diabetes, and waist circumference (WC). In linear regression models, blood Cr levels were negatively associated with the 10-year ASCVD risks after adjustment for covariates (ß = - 0.07, 95% CI = - 0.11 ~ - 0.03); The 3th quartile (Q3) of Se levels was also associated with a lower 10-year ASCVD risks when compared with the lowest quartile (Q1) of Se levels (ßQ3 vs. Q1: - 0.12, 95% CI = - 0.22 ~ - 0.02). In BKMR models, the negative associations of Cr and Se with the 10-year ASCVD risks were observed. Higher blood levels of ETE mixture were associated with decreased 10-year ASCVD risks in a dose-response pattern, with Cr having the highest value of the posterior inclusion probability (PIP) within the mixture. Furthermore, a positive association between Cr and HDL-C and a negative association between Se and SBP were found in both linear regression and BKMR models. Cr and Se were negatively associated with the 10-year ASCVD risks, individually and as a mixture. ETE mixture showed a linear dose-response association with decreased 10-year ASCVD risks, with Cr being the most important component within the mixture. The negative association of the ETE mixture with the 10-year ASCVD risks may be attributed to Cr and Se, mainly mediated by HDL-C and SBP, respectively. Further cohort studies are needed to clarify this association.

The association between essential trace element mixture and cognitive function in Chinese community-dwelling older adults.

BACKGROUND: The evidence about the effect of essential trace element (ETE) mixture on cognitive function amongst older adults is limited. This study aims to evaluate the associations of single ETEs and ETE mixture with cognitive function using a representative sample of community-dwelling older adults in China. METHODS: A total of 3814 older adults were included in the study. Urinary concentrations of selenium (Se), vanadium (V), cobalt (Co), strontium (Sr), and molybdenum (Mo) were detected by inductively coupled plasma mass spectrometry. Cognitive function in older adults was assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Linear regression and Bayesian kernel machine regression (BKMR) were performed to explore the associations of single ETEs and ETE mixture with cognitive function, respectively. RESULTS: Linear regression showed that urinary levels of Se and V were positively associated with MMSE scores in the adjusted single-element models. BKMR also showed marginally positive associations of Se and V with MMSE scores. Moreover, higher urinary levels of ETE mixture were significantly associated with increased MMSE scores in a dose-response pattern, and Se was the most important contributor within the mixture. Both Se and V demonstrated positive additive effects on the associations of other ETEs with MMSE scores, whereas Co had a negative additive effect. CONCLUSIONS: V and Se are positively associated with cognitive function, individually and as a mixture. ETE mixture exhibits a linear dose-response association with improved cognitive function, with Se being the most important component within the mixture. Mixture analyses rather than single ETE analyses may provide a real-world perspective on the relationship between ETE mixture and cognitive function. Further cohort studies are needed to clarify the association of multiple ETEs with cognitive function.

[Associations of hyperlipidemia and its subtypes with blood lead levels in Lu'an City community older adults in 2016].

OBJECTIVE: To explore associations of hyperlipidemia and its subtypes with blood lead levels in community older adults. METHODS: From June to September, 2016, a rural and an urban community in Lu'an City, Anhui Province were randomly selected. Older adults aged 60 years old or over in two communities were recruited to participate, receiving a questionnaire interview(including gender, age, region, education, occupation, marital status, lifestyle, and chronic medical history, etc. ), physical examinations(height, weight, and blood pressure) and laboratory tests(blood glucose, blood lipid, and blood lead levels). A total of 1080 older adults volunteered to participate, of which 1008 had completedata. Inductively coupled plasma mass spectrometry was used to measure concentrations of blood lead. The interquartile range was used to divide the distribution of lead in blood. Logistic regression model was used to examine associations of hyperlipidemia and its subtypes with blood lead levels. Restrictive cubic splineswere used to further determine potential dose-response relationships. RESULTS: Of 1008 older adults, the mean age was(71.9±6.5) years old, 459(45.5%)were male, and 557(55.3%) were from the rural community. The prevalence of hyperlipidemia was 51.2%(n=516). The detection rate and geometric mean of blood lead were 100% and 28.08 µg/L(ranged from 7.89 to 278.33 µg/L), respectively. Univariate analysis showed that older adults in the highest quartile group of blood lead(≥75%) had higher odds of hyperlipidemia(OR=1.42, 95%CI 1.00-2.02) and two subtypes(high total serum cholesterol(OR=1.83, 95%CI 1.25-2.68)and mixed hyperlipidemia(OR=1.49, 95%CI 0.83-2.67)) compared to counterparties in the lowest quartile group(≤25%). After adjustment for gender, age, region, education, occupation, marital status, smoking, drinking, exercise conditions, diet, high blood pressure, diabetes, and body mass index, the ORs for hyperlipidemia and mixed hyperlipidemia in the highest quartile group of blood lead were 1.55(95%CI 1.02-2.36) and 2.87(95%CI 1.44-5.70). The restricted cubic spline curves showed approximate linear relationships between blood lead levels and ORs of hyperlipidemia and mixed hyperlipidemia. CONCLUSION: Linear associations of blood lead levels with hyperlipidemia and mixed hyperlipidemia were found in community older adults.

The associations between urinary metals and metal mixtures and kidney function in Chinese community-dwelling older adults with diabetes mellitus.

BACKGROUND: Previous studies have found associations between single toxic metals, such as arsenic and cadmium, and kidney function in adults with diabetes. However, studies with regards to other metals and metal mixtures are still limited. OBJECTIVE: Our study aimed to investigate the associations between urinary concentrations of 5 selected metals and metal mixtures and kidney function using a sample of older adults with diabetes mellitus in Chinese communities. METHODS: In a sample of older adults (n = 5186), 592 eligible subjects were included in this study. Urinary concentrations of 5 metals, i.e., arsenic (As), cadmium (Cd), vanadium (V), cobalt (Co), and thallium (Tl), were measured by inductively coupled plasma mass spectrometer (ICP-MS). Estimated glomerular filtration rate (eGFR) was calculated and dichotomized into indicator of chronic kidney disease (CKD). Logistic analysis and Bayesian kernel machine regression (BKMR) were used to explore the associations between single metals and metal mixtures and CKD, respectively. RESULTS: Urinary levels of As and V were positively correlated with CKD (OR=2.37, 95% CI: 1.31-4.30 for As; OR=2.24, 95% CI: 1.25-4.03 for V), when compared the 4th quartile with the 1st quartile. After adjustment for potential confounders, the significant association between As and CKD still existed (OR=2.73, 95% CI: 1.23-6.07). BKMR analyses showed strong linear positive associations between As and V and CKD. Higher urinary levels of the mixture were significantly associated with higher odds of CKD in a dose-response pattern. As and V showed the highest posterior inclusion probabilities. CONCLUSION: Urine As and V were positively associated with CKD in older adults with diabetes mellitus, separately and in a mixture. The metals mixture showed a linear dose-response association with the odds of CKD. The analyses of mixtures, rather than of single metals, may provide a real-world perspective on the relationship between metals and kidney function.

Levels and determinants of urinary phthalate metabolites in Chinese community-dwelling older adults.

BACKGROUND: Biomonitoring studies have demonstrated extensive exposure of infants, children, and pregnant women to phthalates, but data on phthalate exposure and their determinants in Chinese older adults remain insufficient. This study aims to assess urinary phthalate metabolite levels, individual and cumulative exposure risk, and their determinants in Chinese community-dwelling older adults. METHODS: A total of 987 individuals aged 60 years or over were included in this study. The urinary levels of seven phthalate metabolites were measured using high-performance liquid chromatography-tandem mass spectrometry. The estimated daily intake (EDI), hazard quotient (HQ), and hazard index (HI) of phthalates were calculated based on urinary metabolite levels. The associations between phthalate metabolite levels and potential determinants were examined using multiple linear regressions. RESULTS: Detection rates of seven phthalate metabolites from the study population ranged from 63.83% to 99.39%. The highest median concentration was 43.64 µg/L (42.59 µg/g creatinine) for mono-butyl phthalate (MBP). The highest median EDI was 1.55 µg/kg-bw/day for diethyl phthalate (DBP). Nearly 5% of participants had high HI values exceeding 1, mainly attributed to DBP and di-2-ethylhexyl phthalate (DEHP). Furthermore, we found that females, higher body mass index (BMI), smoking, having two or more chronic diseases, and vegetable-based diets were significantly associated with higher levels of parts of phthalate metabolites. More interestingly, higher urine levels of high-molecular-weight (HMW) phthalate metabolites and lower urine levels of low-molecular-weight (LMW) phthalate metabolites were found in rural older adults than in urban older adults. CONCLUSIONS: Chinese community-dwelling older adults are extensively exposed to phthalates, especially to DBP and DEHP. More attention should be paid to urban-rural differences in exposure to HMW and LMW phthalates and to phthalate exposure among older adults with overweight/obesity, females, and individuals who are current heavy smokers, have two or more chronic diseases, and consume vegetable-based diets.

The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study.

BACKGROUND: Evidence of the association between marital status and cognitive function in Chinese older adults is limited. AIMS: To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities. METHODS: A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored. RESULTS: In univariate linear regression models, compared to being married, both being widowed (ß [95% CI]: -1.46[-2.78 to - 0.13]) and being single (ß [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (ß [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (ß [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (ß [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (ß [95% CI: 0.88[- 0.87 to 2.64]). DISCUSSION AND CONCLUSIONS: Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.