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1.
Eur J Endocrinol ; 185(5): 765-774, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34524977

RESUMO

Objective: To examine the association of incident type 2 diabetes (T2D) risk with sleep factors, genetic risk, and their combination effects. Design: Large prospective population-based cohort study. Methods: This population-based prospective cohort study included 360 403 (mean (s.d.) age: 56.6 (8.0) years) participants without T2D at baseline from the UK Biobank. Genetic risk was categorised as high (highest quintile), intermediate (quintiles: 2-4), and low (lowest quintile) based on a polygenic risk score for T2D. Sleep scores, including long or short sleep duration, insomnia, snoring, late chronotype, and excessive daytime sleepiness, were categorized as an unfavourable, intermediate, or favourable sleep and circadian pattern. Results: During a median follow-up of 9.0 years, 13 120 incident T2D cases were recorded. Among the participants with an unfavourable sleep and circadian pattern, 6.96% (95% CI: 6.68-7.24%) developed T2D vs 2.37% (95% CI: 2.28-2.46%) of participants with a favourable sleep and circadian pattern (adjusted hazard ratio (HR): 1.53, 95% CI: 1.45-1.62). Of participants with a high genetic risk, 5.53% (95% CI: 5.36-5.69%) developed T2D vs 2.01% (95% CI: 1.91-2.11%) of participants with a low genetic risk (adjusted HR: 2.89, 95% CI: 2.72-3.07). The association with sleep and circadian patterns was independent of genetic risk strata. Participants in the lowest quintile with an unfavourable sleep and circadian pattern were 3.97-fold more likely to develop T2D than those in the lowest quintile with a favourable sleep and circadian pattern. Conclusions: Sleep and circadian patterns and genetic risk were independently associated with incident T2D. These results indicate the benefits of adhering to a healthy sleep and circadian pattern in entire populations, independent of genetic risk.


Assuntos
Ritmo Circadiano/fisiologia , Diabetes Mellitus Tipo 2/epidemiologia , Predisposição Genética para Doença/epidemiologia , Vigilância da População , Transtornos do Sono-Vigília/epidemiologia , Sono/fisiologia , Idoso , Estudos de Coortes , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Seguimentos , Predisposição Genética para Doença/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transtornos do Sono-Vigília/genética , Transtornos do Sono-Vigília/fisiopatologia
2.
Aging (Albany NY) ; 12(11): 10687-10703, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532929

RESUMO

INTRODUCTION: To investigate the independent and joint effects of leisure activities on disability in activities of daily living (ADL) among the oldest-old Chinese population (aged ≥ 80 years). RESULTS: A total of 3696 participants with ADL disability were identified during the median follow-up period of 3.1 years. Compared to the participants who "never" watched TV or listened to the radio and who "never" kept domestic animals or pets, those who engaged in these activities "almost every day" had a significantly lower ADL disability risk (adjusted hazard ratios were 0.74 and 0.66, respectively; both P < 0.001). Furthermore, participants engaging in multiple leisure activities showed a reduced risk of ADL disability (P for trend < 0.001). CONCLUSIONS: Frequently watching TV or listening to the radio and keeping domestic animals or pets was associated with a lower risk of ADL disability among the oldest-old Chinese population. METHODS: We included 12,331 participants (aged ≥ 80 years) (mean [SD] age: 89.5 [7.0] years) who managed to perform ADL independently at baseline in the Chinese Longitudinal Healthy Longevity Survey 1998-2014 waves. Cox proportional hazards models were used to examine whether leisure activities were associated with ADL disability.


Assuntos
Atividades Cotidianas , Pessoas com Deficiência/estatística & dados numéricos , Atividades de Lazer , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Inquéritos Epidemiológicos , Envelhecimento Saudável , Humanos , Estudos Longitudinais , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco
3.
J Clin Endocrinol Metab ; 104(8): 3370-3378, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30869791

RESUMO

CONTEXT: The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear. OBJECTIVE: To examine the association of HDL-C concentrations with mortality and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly. DESIGN: This was a nationwide, community-based, prospective cohort study. PARTICIPANTS: This study included 7766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% CI for all-cause and cause-specific mortality. RESULTS: During a median follow-up of 5.9 years, 1921 deaths occurred. After a full adjustment for covariates, a nonlinear (P < 0.001 for nonlinearity) association was found between HDL-C and all-cause mortality [minimum mortality risk at 71 mg/dL (1.84 mM)]; the risk for all-cause mortality was significantly higher in the groups with HDL-C concentration <61 mg/dL (1.58 mM; HR: 1.18; 95% CI: 1.05 to 1.33) and with HDL-C concentration >87 mg/dL (2.25 mM; HR: 1.56; 95% CI: 1.17 to 2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58 to 2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and noncardiovascular mortality were also observed (both P < 0.001 for nonlinearity). CONCLUSIONS: Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.


Assuntos
Doenças Cardiovasculares/mortalidade , Causas de Morte , HDL-Colesterol/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
4.
Transfusion ; 58(8): 1855-1862, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30145838

RESUMO

BACKGROUND: The aim of this study was to identify the predictors of need for allogenic blood transfusion (ALBT) in primary lower limb total joint arthroplasty (TJA). STUDY DESIGN AND METHODS: This study utilized a large dataset of 15,187 patients undergoing primary unilateral TJA. Risk factors and demographic information were extracted from the electronic health record. A predictive model was developed by both a random forest (RF) algorithm and logistic regression (LR). The area under the receiver operating characteristic curve (AUC-ROC) was used to compare the accuracy of the two methods. RESULTS: The rate of ALBT was 18.9% in total. Patient-related factors associated with higher risk of an ALBT included female sex, American Society of Anesthesiologists (ASA) II, ASA III, and ASA IV. Surgery-related risk factors for ALBT were operative time, drain use, and amount of intraoperative blood loss. Higher preoperative hemoglobin and tranexamic acid use were associated with decreased risk for ALBT. The RF model had a better predictive accuracy (area under the curve [AUC] 0.84) than the LR model (AUC, 0.77; p < 0.001). CONCLUSION: The risk factors identified in the current study can provide specific, personalized perioperative ALBT risk assessment for a patient considering lower limb TJA. Furthermore, the predictive accuracy of the RF algorithm was significantly higher than that of LR, making it a potential tool for future personalized preoperative prediction of risk for perioperative ALBT.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Transfusão de Sangue , Valor Preditivo dos Testes , Idoso , Algoritmos , Registros Eletrônicos de Saúde , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
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