Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aim: To understand the clinical and pathological characteristics of patients with IgA nephropathy (IgAN) complicated by hyperuricemia, and to analyze the time-averaged SUA (TA-SUA) on the prognosis of IgAN.

Methods and results: A retrospective analysis of 718 IgAN patients with diagnosis confirmed by renal biopsy and follow-up of more than 1 year was performed. At least two serum uric acid (SUA) levels were measured at intervals of 0.5-1 year during follow-up. The TA-SUA was calculated according to the area under the curve during the follow-up period. The primary endpoint of the study was the doubling of creatinine or end-stage renal disease. Four groups (Q1-Q4) were divided according to TA-SUA quartile spacing from low to high, and the association of the TA-SUA with prognosis in IgAN patients was assessed using Kaplan-Meier survival analysis and Cox proportional hazards models. This study included 718 patients with IgAN, of whom 181 (25.21 %) had hyperuricemia.Compared with the other three groups, the clinical and pathological characteristics of patients in the fourth quarter were more severe in both baseline SUA and TA-SUA groups. Multivariate results suggested that baseline SUA was not an independent risk factor for renal prognosis in IgAN patients after adjustment for clinical variables such as eGFR. High TA-SUA is an independent risk factor for renal prognosis in IgAN patients.

Conclusions: Hyperuricemia is common in IgA nephropathy.High TA-SUA in IgAN patients show more severe clinical features and pathological damage. TA-SUA is an independent risk factor for renal prognosis in IgA nephropathy patients.

Background and aims: Patients receiving statin therapy still suffer from adverse cardiovascular events. Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is a newly proposed concept that shares common metabolic risk factors with cardiovascular disease. This study aimed to investigate the association between MAFLD and adverse cardiovascular outcomes in coronary heart disease (CHD) patients with LDL-C<1.8 mmol/L.

Methods and results: CHD patients with LDL-C<1.8 mmol/L were divided into MAFLD and non-MAFLD groups. Propensity score matching (PSM) was used to control for baseline differences between the two groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs). All MAFLD patients were further stratified into two groups with and without advanced liver fibrosis, according to the Fibrosis-4 (FIB-4) index cutoffs, and the associations between advanced liver fibrosis status and cardiovascular outcomes were analyzed. After PSM, 800 MAFLD and 800 non-MAFLD patients with LDL-C<1.8 mmol/L were analyzed. MAFLD patients exhibited a significantly greater cumulative incidence and risk of MACCEs than non-MAFLD patients (9.6 % versus 6.6 %, p < 0.05; HR 1.48, 95 % CI 1.04-2.1, p < 0.05). Among MAFLD patients with LDL-C<1.8 mmol/L, advanced liver fibrosis staged by the FIB-4 index was associated with an elevated risk for MACCEs (HR 2.91, 95 % CI 1.17-7.19, p < 0.05), all-cause mortality, myocardial infarction (MI) and stent thrombosis.

Conclusion: MAFLD was an independent risk factor for adverse cardiovascular outcomes in CHD patients with LDL-C<1.8 mmol/L. Additionally, advanced liver fibrosis predicts increased risks for adverse cardiovascular events among MAFLD patients. These findings suggest that MAFLD and liver fibrosis screening and management contribute to the residual cardiovascular risk of CHD patients.

Background and aim: Many scoring systems are used to evaluate malnutrition, but there is no consensus on which scoring system would be more appropriate. We aimed to investigate the effect of malnutrition in patients with non-valvular atrial fibrillation (NVAF) and to compare three scoring systems.

Methods and results: A total of 2592 patients with non-valvular AF from 35 different centers in Turkey were included in this prospective study. All participants were divided into two groups: 761 patients who died and 1831 patients who were alive. The malnutrition status of all participants was evaluated with three scoring systems. The primary outcome was all-cause mortality. The mean age of the population was 68.7 ± 11.1 years, and 55.5 % were female. According to Cox regression analysis, the geriatric nutritional risk index (GNRI) (HR = 0.989, 95 % CI: 0.982-0.997, p = 0.007), controlling nutritional status (CONUT) score (HR = 1.121, 95 % CI: 1.060-1.185, p < 0.001), and prognostic nutritional index (PNI) (HR = 0.980, 95 % CI: 0.962-0.999, p = 0.036) were found to be significant mortality predictors. ROC curve analysis indicated GNRI (AUC = 0.568), CONUT (AUC = 0.572), and PNI (AUC = 0.547) had moderate predictive values. Kaplan-Meier analysis showed that increasing the risk class based on GNRI (p < 0.001) and CONUT (p < 0.001) was associated with decreased survival, while PNI staging had no statistically significant effect (p = 0.266).

Conclusions: Malnutrition, determined by three scoring systems, was found to be an independent predictor of all-cause mortality in NVAF patients. Nutritional examination may provide useful information for prognosis and risk stratification in patients with NVAF.

Background and aims: Whether the new standard of metabolic dysfunction-associated fatty liver disease (MAFLD) has more pronounced clinical and population screening diagnostic value than nonalcoholic fatty liver disease (NAFLD) is unclear. This study evaluated the utility of MAFLD and NAFLD for predicting major cardiovascular disease (CVD) risk.

Methods and results: A prospective cohort study approach was utilized to collect 19,399 study participants without CVD at baseline who completed follow-up from the Jinchang cohort platform during 2011-2017. According to clinical ultrasonic diagnosis results and disease diagnosis criteria, the baseline population was divided into MAFLD, NAFLD, Both-FLD and No-FLD groups. Based on the multifactorial Cox proportional risk model to analyze the relationship between three kinds of patients and CVD, the score prediction model of CVD was constructed with reference to the Framingham Risk Score (FRS) and the model was evaluated. Compared with No-FLD, the HRs and 95 % CIs for the risk of CVD development in patients with NAFLD, MAFLD, and Both-FLD were 1.54 (1.34-1.76), 1.57 (1.37-1.79), and 1.62 (1.41-1.87), in that order. The scoring model showed a range of 5.90%-84.59 % risk of CVD in the three groups. As the risk score increased, the risk of developing CVD gradually increased. Evaluation metrics of all three models in the training set and validation set showed that the models have good prediction efficacy.

Conclusion: In terms of CVD risk and prognosis, MAFLD had no advantage over NAFLD. However, Both-FLD was found to predict a higher risk of CVD and to have superior predictive efficacy.

Background and aims: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) often manifest a combination of cardiometabolic risk factors of varying severity. The cardiometabolic phenotypes and their associations with advanced liver fibrosis and all-cause mortality among patients with MASLD warrant further investigation.

Methods and results: A total of 4209 and 1901 eligible participants were obtained from the National Health and Nutrition Examination Survey and included in the original and replication datasets, respectively. In the original dataset, three distinct and stable cardiometabolic phenotypes were identified using unsupervised cluster analyses, including mild cardiometabolic risk factor (MCMRF) phenotype, overweight combined with high diastolic blood pressure dominated (OCHBP) phenotype, and severe glucose and lipid metabolic dysfunction dominated (SGLMD) phenotype. The above phenotypes were subsequently replicated in the replication dataset, demonstrating similar characteristics. After adjusting for potential covariates, the results of logistic and Cox regression models showed that OCHBP and SGLMD phenotypes were significantly associated with higher odds of advanced liver fibrosis (OCHBP: OR = 4.37, 95 % CI: 1.54-12.35, P = 0.020; SGLMD: OR = 9.66, 95 % CI: 4.76-19.61, P = 0.002) and an increased risk of all-cause mortality (OCHBP: HR = 1.39, 95 % CI: 1.17-1.65, P < 0.001; SGLMD: HR = 2.51, 95 % CI: 1.86-3.40, P < 0.001) compared to the MCMRF phenotype. Moreover, the observed associations remained statistically significant in most subgroups, and a series of sensitivity analyses further confirmed the robustness of these findings.

Conclusion: Three heterogeneous cardiometabolic phenotypes were identified among participants with MASLD, showing significant associations with two critical outcomes. These novel phenotypes may be of great importance to precision medicine in MASLD.

Background and aim: The relationship between the systemic inflammatory response index (SIRI) and carotid atherosclerosis has not yet been assessed in a longitudinal investigation. Our current study aimed to investigate whether SIRI is related to an increased risk of incident carotid plaque.

Methods and results: Our study included individuals who did not have carotid atherosclerosis and had undergone yearly health check-ups at the Department of Health Management of Nanfang Hospital between 2011 and 2018 (total n = 3927). SIRI was computed by a composite value of neutrophils, monocytes, and lymphocytes. Over a median follow-up time of 4.42 years, 872 (22.21 %) participants developed carotid plaque in the entire cohort. The adjusted hazard ratio (HR) for the continuous SIRI was 1.093 (95 % CI: 1.021-1.223) in our present study. In the general population, individuals belonging to the highest quartile of SIRI had an elevated risk of carotid plaque, as compared to those within the lowest quartile (HR 1.122, 95 % CI: 1.011-1.391, P for trend = 0.041). Furthermore, this trend was even more pronounced among participants without hypertension, diabetes and hyperlipidemia in the highest SIRI quartile, who demonstrated a markedly increased risk of carotid plaque when contrasted with those in the lowest quartile (HR 1.277, 95 % CI: 1.041-1.568, P for trend = 0.006).

Conclusions: Our research findings suggest an association between increased SIRI levels and a higher incidence of carotid atherosclerosis, especially among the people without a history of hypertension, diabetes and hyperlipidemia.

Aims: The most frequent consequence of elevated uric acid (UA) levels is the development of gout and urate kidney disease. Besides these effects, several studies have investigated the association between hyperuricemia and cardiovascular (CV) disease. High serum UA has been identified as an important determinant of all-cause and CV mortality and CV events (acute and chronic coronary syndrome, stroke and peripheral artery disease). Despite the high number of publications on this topic, there are two questions that are still unanswered: do we need a specific CV cut-off of serum UA to better refine the CV risk? Is urate lowering treatment (ULT) able to reduce CV risk in asymptomatic patients? In this review, we will focus on these two points.

Data synthesis: Although no doubt exists that the relationship between CV events starts at lower levels than the actually used cut-off, different papers found dissimilar cut-offs. Furthermore, heterogeneity is present depending on the specific CV events evaluated and none of the found cut-off have been tested in external populations (in order to confirm its discriminatory capacity). Furthermore, only few randomized clinical trials on the role of hypouricemic agents in reducing the CV risk have been published giving heterogeneous results. The last published one (ALL-HEART) has strong limitations, that we will deeply discuss.

Conclusions: A definitive answer to the two questions is impossible with the actually published paper but, over identifying current gaps in knowledge we try to individuate how they can be overruled.

Background and aims: The impact of dietary live microbe intake on adolescent obesity is still not fully understood. This study aims to investigate the potential relationship between dietary live microbe intake and obesity among U.S adolescents, and to explore the mediating role of physical activity (PA).

Methods and results: Data from NHANES (1999-2018) were analyzed, and dietary live microbe intake was categorized into low, medium, and high groups using a developed framework. Survey-weighted logistic regression and mediation analysis models were used to examine the association between live microbe intake and adolescent obesity, as well as the potential mediating effect of PA. Our study included 8443 participants aged 6-18, representing the noninstitutionalized U.S population of 184.5 million. We found that participants with a high dietary intake of live microbes had lower odds of developing obesity compared to those with the lowest exposure to live microbes (AOR = 0.900, 95 % CI: 0.812, 0.997). Additionally, our mediation analysis revealed a significant indirect effect of live microbes on obesity risk through PA (P-value <0.001), with 39.4 % (95 % CI: 24.5 %, 86.5 %) of the effect mediated by PA.

Conclusion: Our study highlights the association between consuming a higher amount of live microbes in the diet and a decreased risk of obesity among U.S adolescents. It also suggests that PA may act as a mediator in this relationship. Therefore, it is crucial to emphasize the incorporation of both dietary interventions and PA in the development of prevention and therapy policies for managing adolescent obesity.

Background and aims: In contrast to the substantial body of clinical trial evidence, the real-world evidence regarding the efficacy of statins in the prevention of cardiovascular events among patients with type 2 diabetes mellitus (T2DM) is relatively limited. Therefore, we assessed the effectiveness of atorvastatin for the primary prevention of CV events in patients with T2DM, using a population-based data in South Korea.

Methods and results: This retrospective cohort study was conducted using the National Health Insurance Service Customized Database (2008-2018) in South Korea. We identified atorvastatin users and statin non-users with T2DM without history of cancer or CV events. The two groups were matched using propensity scores. The association between CV events and atorvastatin was estimated using an extended Cox model with the Heaviside function (split at 3 years). We identified 41 024 atorvastatin users and 41 024 statin non-users (mean age: 58.1 and 58.2 years, respectively). The incidence rate and case fatality rate of CV events were higher in statin non-users than in atorvastatin users. Atorvastatin significantly reduced the risk of CV events after 3 years of treatment (hazard ratio [HR]: 0.98 (95 % confidence interval: 0.90-1.05) and 0.76 (0.72-0.80) within and after 3 years, respectively). The HR for stroke was lower than that for coronary heart disease.

Conclusion: In real-world patients with T2DM without a history of CV events, atorvastatin was associated with a decreased risk of CV events after 3 years of treatment.