Journal of Health, Population, and Nutrition最新文献

Background: Multiple inflammatory markers are central determinants of insulin resistance and cardiovascular inflammation, closely associated with cardiometabolic multimorbidity (CMM). However, the evidence regarding the impact of their long-term elevation on CMM remains limited.

Methods: We analyzed data from 4,602 CHARLS participants free of cardiometabolic multimorbidity (CMM) at the 2011 baseline, with follow-up through 2018 to assess CMM incidence. Six cumulative inflammatory indices (Cumulative C-reactive protein-triglyceride-glucose index, Cumulative C-reactive protein, Cumulative white blood cell count, cumulative inflammatory score, Cumulative ratio of C-reactive protein to high-density lipoprotein, Cumulative high-density lipoprotein) were evaluated for associations with CMM risk. Each cumulative index was calculated as the product of the average value of an inflammatory marker across the first and third study waves and the total exposure duration. Multivariable Cox proportional hazards regression, restricted cubic spline regression, subgroup analyses, and interaction tests were performed to assess risk associations, nonlinear relationships, and heterogeneity. To validate the applicability of these indices in diverse populations, we conducted external validation using another large-scale longitudinal cohort-the English Longitudinal Study of Ageing (ELSA) database.

Results: cumCRP, cumWBC, cumCRP/HDL, and the cumulative inflammatory score were significantly positively associated with CMM risk, while cumHDL showed a negative linear relationship with CMM outcomes. Among them, cumCTI exhibited the strongest association with CMM incidence, with a hazard ratio (HR) of 2.19 (95% confidence interval [CI]: 1.61-2.98) compared to the first quartile. Area under the curve (AUC) values in three confounder-adjusted models were 0.619, 0.641, and 0.726, respectively. Additionally, several cumulative inflammatory indicators showed multiplicative interactions with gender, dyslipidemia, and body mass index (BMI) in relation to CMM risk. External validation in the ELSA database demonstrated that cumCTI remained the strongest predictor of CMM incidence among all cumulative inflammatory indices, with a receiver operating characteristic (ROC) curve area under the curve (AUC) of 0.75 and a hazard ratio (HR) of 3.28 (95% CI: 1.52-7.91).

Conclusion: This study demonstrates associations between six cumulative inflammatory indices and CMM risk. Individuals with elevated C-reactive protein-triglyceride-glucose index (CTI) require heightened vigilance for the development of CMM. Long-term monitoring of CTI fluctuations may facilitate early prevention and mitigation of CMM.

Background: Parenteral nutrition (PN) preparations are listed as high-alert medications and have a high probability of medication errors (MEs). Board-certified Nutrition Support Pharmacists (BCNSPs) can play an important role in reducing PN-associated complications by highlighting the gaps in the PN prescribing process. This study aimed to determine the impact of BCNSP-led PN review on the identification and documentation of prescribing MEs (PMEs) to optimize quality and safety in PN prescribing processes.

Methods: This QI quasi-experimental study included all neonates admitted to a level III neonatal intensive care unit (NICU) and prescribed PN. All identified and recognized PN-PMEs documented by pharmacists were evaluated in pre-and post-implementation-phases. In the pre-phase, the PN-duty pharmacist reviewed all the neonatal PN-orders while located in the pharmacy, and in the post-phase, a clinically involved BCNSP performed this task. All PN-PMEs were categorized into ten types. Predictors of PN-PMEs were analyzed through logistic regression.

Results: PN-orders were prescribed to 98 and 112 neonates in pre-and post-phases, respectively. For demographic and clinical variables, neonates were comparable. A median of 12 (range = 9 - 19) vs. 15 (range = 12-22) PN-orders/day were reviewed in pre-and post-phases. Documented PN-PMEs for all PN orders were significantly higher in the post-phase (212/2577, 8.23%) compared with the pre-phase (25/2577, 0.97%; p < 0.001). "Wrong Dose/Calculation" was the most reported category (88/2577, 3.41%). "Wrong concentration range" was the second highest (29/1309, 2.22%) and all were reported only in post-phase. Additional errors involved infusion, compatibility, and osmolarity deviations, renal/hepatic dose adjustment errors and stability errors. Most of them were only identified in the post-phase. Post-phase outcomes showed clinically meaningful reductions in metabolic derangements, NICU stay, and mortality (p < 0.001).

Conclusion: The engagement of BCNSPs in the clinical neonatal setting for PN management may improve the safety and efficacy of PN-therapy.

Objectives: The relationship between metabolic dysregulation and frailty remains incompletely understood. This study examines the association between metabolic dysregulation and frailty in middle-aged and older adults.

Methods: Data from four cohorts (CHARLS, HRS, SHARE, MHAS) were analysed. Frailty was assessed using a 30-item deficit accumulation frailty index, treated as a continuous variable ranging from 0-100. Metabolic dysregulation was defined based on the presence of central obesity, high blood pressure, and/or hyperglycaemia, and was analysed both as a categorical count variable (0, 1, 2, or 3 dysregulations) and as specific combinations of individual metabolic components. Multivariable linear regression models were used to examine associations, adjusting for demographic, lifestyle, and clinical factors.

Results: Among 416,693 participants, 63.7% had at least one metabolic dysregulation. A dose-response pattern was observed: β-values for frailty were 4.31 (95% CI: 4.22-4.40) for one dysregulation, 8.36 (95% CI: 8.24-8.49) for two, and 12.92 (95% CI: 12.79-13.16) for three. Hyperglycemia had the strongest effect, especially when combined with high blood pressure, and remained significant after adjustment.

Conclusion: Metabolic dysregulation synergistically accelerates frailty progression, underscoring the need for early intervention in metabolic disorders to prevent frailty.

Background: Coffee is among the most widely consumed beverages globally, yet evidence specifically examining its association with heart failure (HF) risk remains limited. The only dedicated meta-analysis on this topic was published in 2012. We conducted an updated systematic review and dose-response meta-analysis to comprehensively evaluate the association between coffee consumption and incident HF.

Methods: We searched PubMed, Embase and Scopus from January 2012 through October 2025 to update the original meta-analysis. Prospective cohort studies reporting hazard ratios for coffee consumption and incident HF were included. Random-effects models were used to pool estimates. Subgroup analyses were planned to examine effects by sex, geographic region, coffee type, and population characteristics where possible. Certainty of evidence was assessed using GRADE.

Results: Thirteen studies comprising 656,666 participants and 20,646 HF events were identified. Pooled analysis of 7 independent cohorts demonstrated that moderate coffee consumption (2-4 cups/day) was associated with significantly reduced HF risk (HR 0.925; 95% CI 0.882-0.971; P = 0.002) with negligible heterogeneity (I²=0%). A J-shaped dose-response pattern was suggested, although the test for non-linearity was borderline significant (P = 0.066), with maximal benefit observed at 1-2 cups/day. Within-cohort analyses indicated similar associations for caffeinated and decaffeinated coffee. No evidence of publication bias was detected (Egger's P = 0.99). Certainty of evidence was rated as low.

Conclusions: This updated meta-analysis suggests moderate coffee consumption is linked to lower incident heart failure risk, though certainty is low. Associations observed within-cohort analyses were similar for caffeinated and decaffeinated coffee, indicating moderate intake may be compatible within heart-healthy dietary patterns.

Review registration: (PROSPERO Registration ID: CRD420251269118).

Introduction: Sustainability in food systems has been widely discussed due to the environmental, social and economic impacts of collective meal production. University restaurants play a strategic role due to the large volume of meals served daily, ensuring students' access to food security and serving as ideal environments for implementing sustainable practices. However, there are still gaps in the understanding of the main strategies adopted and the dimensions of sustainability most frequently assessed in these spaces.

Methods: This study carried out a scoping review, following the guidelines of the Joanna Briggs Institute (JBI) and writing according to PRISMA-SCR, with the aim of identifying the main sustainability strategies applied in university restaurants and mapping the stages of the production process most investigated in the scientific literature. The search was conducted in databases such as PubMed, Embase, Scopus, and the Virtual Health Library, and it included quantitative studies that evaluated aspects of sustainability in these restaurants. The extracted data was analyzed and categorized according to the principles of the 5Rs (Rethink, Reduce, Reuse, Recycle and Refuse).

Results: 58 studies were included, 52.54% from South America, with Brazil predominating. Most of the research focused on the post-distribution phase (70.69%), with a focus on waste management and food waste. The sustainability principle most frequently addressed was "Reduce" (91.4%), followed by "Rethink" (50%), while "Reuse" and "Refuse" were little explored. Strategies aimed at changing menus and educational campaigns targeting consumers were the predominant interventions.

Conclusion: Sustainability in university restaurants has been mostly addressed through waste reduction, with limited focus on structural changes and on the broader 5Rs framework. Future studies should integrate environmental strategies with nutritional adequacy, dietary quality, and student health to maximize the impact of sustainable initiatives in these settings.

Background: Remnant cholesterol and systemic inflammation are two key, interrelated pathways in atherosclerosis. We examined whether the remnant cholesterol inflammatory index (RCII; remnant cholesterol × C-reactive protein/10) predicts incident cardiovascular disease (CVD) among adults in early cardiovascular-kidney-metabolic (CKM) stages.

Methods: We analyzed 5,961 China Health and Retirement Longitudinal Study participants aged ≥ 45 years (baseline 2015; follow-up through 2020) classified as CKM stages 0-3 and free of baseline CVD. Incident CVD (heart disease or stroke) was identified from self-reported physician diagnoses. We used multivariable Cox models with hierarchical adjustment, assessed dose-response patterns using restricted cubic splines, and conducted prespecified subgroup and exploratory mediation analyses.

Results: Over a median follow-up of 5.00 years (IQR, 5.00-5.09), 1,080 incident CVD occurred (18.1%). Each 1-unit increase in log-RCII was associated with higher CVD risk in the fully adjusted model (hazard ratio [HR] 1.070, 95% CI 1.016-1.127; P = 0.010). Compared with quartile 1, quartile 4 had increased risk (HR 1.239, 95% CI 1.029-1.492; P = 0.024; P for trend = 0.043). The dose-response association was linear (P for nonlinearity = 0.795), and no effect modification was detected (all P for interaction > 0.05). Systolic blood pressure mediated 5.0% (95% CI 1.10% to 17.00%) of the RCII-CVD association.

Conclusions: Higher RCII was modestly associated with incident CVD across early CKM stages, suggesting a simple research marker to identify individuals at higher risk during a prevention window. Standardized thresholds and external validation of incremental predictive value are needed before clinical use.

Background: Obesity prevalence has been rising globally, including in Jordan. This study seeks to examine the socio-demographic factors associated with obesity among adult ever-married women in Jordan, utilizing the most recent data from the 2023 JPFHS.

Methods: This cross-sectional study analyzed data from the 2023 JDHS, encompassing a representative sample of 4,048 Jordanian women aged 15-49. Socioeconomic variables examined included age, education level, wealth index, urban or rural residence, and media consumption habits (television, radio, magazines/newspapers, internet usage) along with smoking status. Multivariate logistic regression was employed to determine the associations between these factors and obesity risk.

Results: Of the 4,048 married women included in the analysis, 1,697 (41.9%) had a normal BMI, while 2,351 (58.1%) were classified as obese. Multivariate analysis revealed that increasing age (45-49 years: AOR 20.93, 95% CI 13.40-32.70), daily internet use (AOR 1.33, 95% CI 1.02-1.74), listening to the radio less than once a week (AOR 1.40, 95% CI 1.03-1.91), and residing in Karak (AOR 2.13, 95% CI 1.34-3.38) or Ajloun (AOR 1.75, 95% CI 1.12-2.72) were significantly associated with higher odds of obesity. Conversely, reading newspapers or magazines at least once a week and daily cigarette smoking were linked to a reduced risk of obesity. No significant associations were observed between obesity and place of residence, wealth index, educational level, television viewing habits, or residence in other governorates.

Conclusion: With obesity rates continuing to rise, targeted health programs for Jordanian women of reproductive age are essential. National health initiatives should focus on promoting healthy lifestyle habits, addressing regional disparities, and encouraging balanced media consumption to mitigate obesity risk. Region-specific prevention and awareness campaigns are also vital for effective intervention.