Pub Date : 2026-05-01Epub Date: 2025-12-18DOI: 10.1016/j.numecd.2025.104529
Evan H Whitehead, Jeffrey Bennett, Pavan Bhat, Sanjeeb Bhattacharya, Angelika L Erwin, Karlee Hoffman, Eileen Hsich, Tahir S Kafil, Mazhar Khalil, Ran Lee, Maria M Mountis, E Rene Rodriguez, Edward G Soltesz, Carmela Tan, Michael Z Tong, Timothy F Tramontana, Anthony Zaki, W H Wilson Tang
Background and aim: Propionic acidemia (PA) is a genetic metabolic disorder caused by deficient activity of the enzyme propionyl-CoA carboxylase, resulting in accumulation of toxic metabolites during catabolism of odd-chain fatty acids and branched-chain amino acids. Most PA occurs in compound heterozygotes, typically presenting with metabolic acidosis and seizures in infancy. A milder phenotype of PA is prevalent in the Amish population due to a founder missense variant in PCCB (c.1606 A > G; p.Asn536Asp) and is frequently present as an isolated dilated cardiomyopathy in adolescence.
Methods and results: Here we report our experience with three Amish patients with genetically confirmed PA and end-stage heart failure. While one patient underwent successful heart transplantation with no complications, another developed recurrent cardiogenic shock after transplant due to metabolic decompensation. Based on this experience, a subsequent patient was treated with combined heart/liver transplantation.
Conclusions: These cases highlight unique challenges in managing patients with metabolic cardiomyopathies and emphasize the importance of a multidisciplinary approach to achieve the best possible outcomes.
{"title":"Heart and heart-liver transplantation in Amish patients with propionic acidemia.","authors":"Evan H Whitehead, Jeffrey Bennett, Pavan Bhat, Sanjeeb Bhattacharya, Angelika L Erwin, Karlee Hoffman, Eileen Hsich, Tahir S Kafil, Mazhar Khalil, Ran Lee, Maria M Mountis, E Rene Rodriguez, Edward G Soltesz, Carmela Tan, Michael Z Tong, Timothy F Tramontana, Anthony Zaki, W H Wilson Tang","doi":"10.1016/j.numecd.2025.104529","DOIUrl":"10.1016/j.numecd.2025.104529","url":null,"abstract":"<p><strong>Background and aim: </strong>Propionic acidemia (PA) is a genetic metabolic disorder caused by deficient activity of the enzyme propionyl-CoA carboxylase, resulting in accumulation of toxic metabolites during catabolism of odd-chain fatty acids and branched-chain amino acids. Most PA occurs in compound heterozygotes, typically presenting with metabolic acidosis and seizures in infancy. A milder phenotype of PA is prevalent in the Amish population due to a founder missense variant in PCCB (c.1606 A > G; p.Asn536Asp) and is frequently present as an isolated dilated cardiomyopathy in adolescence.</p><p><strong>Methods and results: </strong>Here we report our experience with three Amish patients with genetically confirmed PA and end-stage heart failure. While one patient underwent successful heart transplantation with no complications, another developed recurrent cardiogenic shock after transplant due to metabolic decompensation. Based on this experience, a subsequent patient was treated with combined heart/liver transplantation.</p><p><strong>Conclusions: </strong>These cases highlight unique challenges in managing patients with metabolic cardiomyopathies and emphasize the importance of a multidisciplinary approach to achieve the best possible outcomes.</p>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":" ","pages":"104529"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aims: Sustainable diets are increasingly recognized as a key strategy to promote human health while reducing environmental impacts. The Planetary Health Diet (PHD) provides a global framework for sustainable and healthy eating patterns, but evidence on its adherence and implications in specific populations is still limited. The aim of this study was to test the level of adherence, the environmental impact, and the nutritional quality of several scores assessing the level of adherence to the PHD in a cohort of Italian individuals.
Methods and results: Dietary habits were assessed through validated food frequency questionnaires while various scores have been applied to evaluate the level of adherence to PHD (ELD-I, EAT, PHDI-Cacau, NB-EAT, PHDI-Bui) in 1936 Italian adults, using the Mediterranean diet (MEDI-LITE) as reference. The environmental impact was quantified as carbon and water footprints (CF and WF) using the SU-EATABLE LIFE database. Higher adherence to PHD-related indices generally corresponded to healthier nutrient profiles, higher fiber intake, and better concordance with Italian dietary recommendations, although some indices predicted lower intake of certain nutrients (e.g., vitamin B12, calcium). The MEDI-LITE index consistently predicted higher adequacy across dietary and nutrient recommendations. Absolute CF and WF showed mixed trends across indices, while energy-standardized values (per 1000 kcal) indicated lower impacts for all PHD-related scores, apart from the ELD-I. Adherence to the Mediterranean diet was also associated with favorable energy-adjusted environmental outcomes.
Conclusion: These findings reinforce the existing alignment between the intrinsic characteristics of the Mediterranean diet with both nutrition and sustainability objectives.
{"title":"Association of planetary health diet indices with diet composition, nutritional quality and environmental impacts in Italian adults.","authors":"Massimiliano Tucci, Daniela Martini, Justyna Godos, Marco Antonio Olvera-Moreira, Ujué Fresán, Francesca Giampieri, Evelyn Frias-Toral, Raynier Zambrano-Villacres, Marilena Vitale, Annalisa Giosuè, Saverio Stranges, Licia Iacoviello, Emilia Ruggiero, Marialaura Bonaccio, Giuseppe Grosso","doi":"10.1016/j.numecd.2025.104537","DOIUrl":"10.1016/j.numecd.2025.104537","url":null,"abstract":"<p><strong>Background and aims: </strong>Sustainable diets are increasingly recognized as a key strategy to promote human health while reducing environmental impacts. The Planetary Health Diet (PHD) provides a global framework for sustainable and healthy eating patterns, but evidence on its adherence and implications in specific populations is still limited. The aim of this study was to test the level of adherence, the environmental impact, and the nutritional quality of several scores assessing the level of adherence to the PHD in a cohort of Italian individuals.</p><p><strong>Methods and results: </strong>Dietary habits were assessed through validated food frequency questionnaires while various scores have been applied to evaluate the level of adherence to PHD (ELD-I, EAT, PHDI-Cacau, NB-EAT, PHDI-Bui) in 1936 Italian adults, using the Mediterranean diet (MEDI-LITE) as reference. The environmental impact was quantified as carbon and water footprints (CF and WF) using the SU-EATABLE LIFE database. Higher adherence to PHD-related indices generally corresponded to healthier nutrient profiles, higher fiber intake, and better concordance with Italian dietary recommendations, although some indices predicted lower intake of certain nutrients (e.g., vitamin B12, calcium). The MEDI-LITE index consistently predicted higher adequacy across dietary and nutrient recommendations. Absolute CF and WF showed mixed trends across indices, while energy-standardized values (per 1000 kcal) indicated lower impacts for all PHD-related scores, apart from the ELD-I. Adherence to the Mediterranean diet was also associated with favorable energy-adjusted environmental outcomes.</p><p><strong>Conclusion: </strong>These findings reinforce the existing alignment between the intrinsic characteristics of the Mediterranean diet with both nutrition and sustainability objectives.</p>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":" ","pages":"104537"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-20DOI: 10.1016/j.numecd.2026.104572
Minseol Jang, Miryoung Kim, Hae Sun Suh
Background and aim: Sodium-glucose cotransporter-2 (SGLT2) inhibitors, a widely used class of oral antidiabetic agents provide additional cardioprotective and renoprotective benefits, but their use during pregnant remains limited. This study aimed to evaluate the association between SGLT2 inhibitor exposure during pregnancy and the risk of congenital malformations.
Methods and results: This population-based cohort study utilized data from the National Health Insurance Service Database (2016-2022). Pregnancies with known teratogen exposure were excluded. SGLT2 inhibitor or insulin (as active comparator) use during the first trimester was defined as exposure. The primary outcomes were congenital malformations and heart defects. Propensity score matching controlled for confounders, and generalized linear regression estimated relative risks (RRs) with 95 % confidence intervals (CIs). Negative control outcomes were employed to assess residual confounding. Among 536,654 pregnancies, 121 pregnancies were exposed to SGLT2 inhibitors (mean [SD] age: 35.07 [4.26]), and 2007 to insulin (mean [SD] age: 34.89 [4.28]). Adjusted RRs (95 % CIs) for congenital malformations and heart defects were 0.88 (0.52-1.46) and 0.83 (0.44-1.58), respectively. In sensitivity analysis restricted to the organogenesis period (gestational weeks 4-10), risk of congenital heart defects was 2.79 (1.16-7.06). No residual confounding detected in negative control outcome.
Conclusions: In this study, SGLT2 inhibitor use during the first trimester was not associated with an increased risk of congenital malformations. Nonetheless, the observed increased risk of congenital heart defects during the organogenesis period highlights the importance of exposure timing and warrants cautious interpretation. These findings provide evidence to guide clinical decision-making regarding antidiabetic medication use during pregnancy.
{"title":"Sodium glucose transporter 2 inhibitor exposure and the risk of congenital malformations: nationwide birth cohort study.","authors":"Minseol Jang, Miryoung Kim, Hae Sun Suh","doi":"10.1016/j.numecd.2026.104572","DOIUrl":"10.1016/j.numecd.2026.104572","url":null,"abstract":"<p><strong>Background and aim: </strong>Sodium-glucose cotransporter-2 (SGLT2) inhibitors, a widely used class of oral antidiabetic agents provide additional cardioprotective and renoprotective benefits, but their use during pregnant remains limited. This study aimed to evaluate the association between SGLT2 inhibitor exposure during pregnancy and the risk of congenital malformations.</p><p><strong>Methods and results: </strong>This population-based cohort study utilized data from the National Health Insurance Service Database (2016-2022). Pregnancies with known teratogen exposure were excluded. SGLT2 inhibitor or insulin (as active comparator) use during the first trimester was defined as exposure. The primary outcomes were congenital malformations and heart defects. Propensity score matching controlled for confounders, and generalized linear regression estimated relative risks (RRs) with 95 % confidence intervals (CIs). Negative control outcomes were employed to assess residual confounding. Among 536,654 pregnancies, 121 pregnancies were exposed to SGLT2 inhibitors (mean [SD] age: 35.07 [4.26]), and 2007 to insulin (mean [SD] age: 34.89 [4.28]). Adjusted RRs (95 % CIs) for congenital malformations and heart defects were 0.88 (0.52-1.46) and 0.83 (0.44-1.58), respectively. In sensitivity analysis restricted to the organogenesis period (gestational weeks 4-10), risk of congenital heart defects was 2.79 (1.16-7.06). No residual confounding detected in negative control outcome.</p><p><strong>Conclusions: </strong>In this study, SGLT2 inhibitor use during the first trimester was not associated with an increased risk of congenital malformations. Nonetheless, the observed increased risk of congenital heart defects during the organogenesis period highlights the importance of exposure timing and warrants cautious interpretation. These findings provide evidence to guide clinical decision-making regarding antidiabetic medication use during pregnancy.</p>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":" ","pages":"104572"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-05DOI: 10.1016/j.numecd.2025.104517
Luis E. Simental-Mendía , Martha Sosa-Macías , Laura Jazel Barragán-Zúñiga , Carlos Galaviz-Hernández , Blanca P. Lazalde-Ramos
Background and aims
Metabolic syndrome (MetS) includes central obesity, hyperglycemia, insulin resistance, atherogenic dyslipidemia, and hypertension. In Mexico, it also affects Indigenous populations which have difficulties to get opportune diagnostic procedures. Therefore, this study aimed to examine the effectiveness of the TyG index in identifying MetS among different Indigenous groups from Northwest Mexico.
Methods and results
A cross-sectional study was conducted on Indigenous and Mestizo populations from Northwest Mexico. Ethnicity was confirmed on each volunteer by evaluation of 15 short tandem repeats loci. Thus, Coras, Huicholes, Mexicaneros, Tarahumaras, Tepehuanos, and Mestizos were included. MetS was diagnosed using the ATP III criteria and the TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. ROC curve was used to detect the best cut-off point for MetS identification, area under the curve, sensitivity, and specificity. A total of 472 subjects were enrolled in the study, including Mestizos (n = 48), Coras (n = 73), Huicholes (n = 93), Mexicaneros (n = 74), Tarahumaras (n = 81), and Tepehuanos (n = 103). Adjusted logistic regression analysis revealed that Coras (OR = 3.81; 95 % confidence interval: 1.58–9.16), Huicholes (OR = 2.74; 95 % confidence interval: 1.03–7.31), Mexicaneros (OR = 4.31; 95 % confidence interval: 1.55–11.9), and Tarahumaras (OR = 5.31; 95 % confidence interval: 1.97–14.3) had a direct association with MetS. A cut-off point of 4.66 for the TyG index demonstrated an AUC, sensitivity, and specificity of 0.885, 84 %, and 82 %, respectively, for the detection of MetS in Indigenous populations.
Conclusions
The results of our study suggest that the TyG index is a useful tool for detecting MetS in Indigenous populations of Northwest Mexico.
{"title":"The triglyceride and glucose index as a surrogate biomarker for the identification of metabolic syndrome in Mexican Indigenous populations","authors":"Luis E. Simental-Mendía , Martha Sosa-Macías , Laura Jazel Barragán-Zúñiga , Carlos Galaviz-Hernández , Blanca P. Lazalde-Ramos","doi":"10.1016/j.numecd.2025.104517","DOIUrl":"10.1016/j.numecd.2025.104517","url":null,"abstract":"<div><h3>Background and aims</h3><div>Metabolic syndrome (MetS) includes central obesity, hyperglycemia, insulin resistance, atherogenic dyslipidemia, and hypertension. In Mexico, it also affects Indigenous populations which have difficulties to get opportune diagnostic procedures. Therefore, this study aimed to examine the effectiveness of the TyG index in identifying MetS among different Indigenous groups from Northwest Mexico.</div></div><div><h3>Methods and results</h3><div>A cross-sectional study was conducted on Indigenous and Mestizo populations from Northwest Mexico. Ethnicity was confirmed on each volunteer by evaluation of 15 short tandem repeats loci. Thus, Coras, Huicholes, Mexicaneros, Tarahumaras, Tepehuanos, and Mestizos were included. MetS was diagnosed using the ATP III criteria and the TyG index was calculated as the <em>Ln</em> [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. ROC curve was used to detect the best cut-off point for MetS identification, area under the curve, sensitivity, and specificity. A total of 472 subjects were enrolled in the study, including Mestizos (n = 48), Coras (n = 73), Huicholes (n = 93), Mexicaneros (n = 74), Tarahumaras (n = 81), and Tepehuanos (n = 103). Adjusted logistic regression analysis revealed that Coras (OR = 3.81; 95 % confidence interval: 1.58–9.16), Huicholes (OR = 2.74; 95 % confidence interval: 1.03–7.31), Mexicaneros (OR = 4.31; 95 % confidence interval: 1.55–11.9), and Tarahumaras (OR = 5.31; 95 % confidence interval: 1.97–14.3) had a direct association with MetS. A cut-off point of 4.66 for the TyG index demonstrated an AUC, sensitivity, and specificity of 0.885, 84 %, and 82 %, respectively, for the detection of MetS in Indigenous populations.</div></div><div><h3>Conclusions</h3><div>The results of our study suggest that the TyG index is a useful tool for detecting MetS in Indigenous populations of Northwest Mexico.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104517"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-04DOI: 10.1016/j.numecd.2025.104514
Jinyan Lei , Yuansong Zhuang , Siqi Tang , Yuxiong Chen , Yitao Han , Yakun Zhao , Yanbo Liu , Zhongjie Fan
Background and aims
Obesity and metabolic status are closely associated with cardiovascular outcomes. However, the prognostic value of metabolic phenotypes in patients with premature acute myocardial infarction (PAMI) remains unclear. This study aims to investigate the relationship between metabolic phenotypes and long-term cardiovascular outcomes in PAMI patients.
Methods and results
This study included 760 AMI patients aged ≤35 years from two medical centers in Beijing. Participants were categorized into four groups: metabolically healthy non-obese (MHN), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUN), and metabolically unhealthy obese (MUO). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Multivariable Cox regression models, Kaplan-Meier curves and subgroup analyses were used to evaluate the association between metabolic phenotypes and MACCE. During a median follow-up of 77 months, a total of 158 MACCE were recorded. Patients with MUO exhibited a higher risk of MACCE (MHN as reference: HR = 1.87, 95 %CI: 1.18–2.94, p = 0.007; MHO as reference: HR = 1.77, 95 %CI: 1.10–2.83, p = 0.018). Notably, the risk of revascularization was elevated in MUO. The robustness of our study findings was supported by consistent results across subgroup and sensitivity analyses.
Conclusions
MUO is associated with adverse outcomes in PAMI patients, suggesting it may serve as an independent predictor of poor prognosis in this population.
背景和目的：肥胖和代谢状态与心血管结局密切相关。然而，代谢表型在过早急性心肌梗死（PAMI）患者中的预后价值尚不清楚。本研究旨在探讨PAMI患者代谢表型与长期心血管预后之间的关系。方法和结果：本研究包括760例年龄≤35岁的AMI患者，来自北京两家医疗中心。参与者被分为四组：代谢健康的非肥胖（MHN）、代谢健康的肥胖（MHO）、代谢不健康的非肥胖（MUN）和代谢不健康的肥胖（MUO）。主要终点是主要心脑血管不良事件（MACCE）。采用多变量Cox回归模型、Kaplan-Meier曲线和亚组分析来评估代谢表型与MACCE之间的关系。在中位随访77个月期间，共记录了158例MACCE。MUO患者发生MACCE的风险较高（MHN为参照：HR = 1.87, 95% CI: 1.18-2.94, p = 0.007； MHO为参照：HR = 1.77, 95% CI: 1.10-2.83, p = 0.018）。值得注意的是，MUO患者血运重建的风险升高。我们的研究结果的稳健性得到了跨亚组和敏感性分析一致结果的支持。结论：在PAMI患者中，MUO与不良结局相关，提示其可作为该人群不良预后的独立预测因子。
{"title":"Prognostic impact of metabolic phenotypes in young adults (≤ 35 Years) with premature acute myocardial infarction: A Beijing-based two-center retrospective study","authors":"Jinyan Lei , Yuansong Zhuang , Siqi Tang , Yuxiong Chen , Yitao Han , Yakun Zhao , Yanbo Liu , Zhongjie Fan","doi":"10.1016/j.numecd.2025.104514","DOIUrl":"10.1016/j.numecd.2025.104514","url":null,"abstract":"<div><h3>Background and aims</h3><div>Obesity and metabolic status are closely associated with cardiovascular outcomes. However, the prognostic value of metabolic phenotypes in patients with premature acute myocardial infarction (PAMI) remains unclear. This study aims to investigate the relationship between metabolic phenotypes and long-term cardiovascular outcomes in PAMI patients.</div></div><div><h3>Methods and results</h3><div>This study included 760 AMI patients aged ≤35 years from two medical centers in Beijing. Participants were categorized into four groups: metabolically healthy non-obese (MHN), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUN), and metabolically unhealthy obese (MUO). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Multivariable Cox regression models, Kaplan-Meier curves and subgroup analyses were used to evaluate the association between metabolic phenotypes and MACCE. During a median follow-up of 77 months, a total of 158 MACCE were recorded. Patients with MUO exhibited a higher risk of MACCE (MHN as reference: HR = 1.87, 95 %CI: 1.18–2.94, <em>p</em> = 0.007; MHO as reference: HR = 1.77, 95 %CI: 1.10–2.83, <em>p</em> = 0.018). Notably, the risk of revascularization was elevated in MUO. The robustness of our study findings was supported by consistent results across subgroup and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>MUO is associated with adverse outcomes in PAMI patients, suggesting it may serve as an independent predictor of poor prognosis in this population.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104514"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-02DOI: 10.1016/j.numecd.2025.104483
David Garcia-Vega , Sergio Cinza-Sanjurjo , Carlos Tilves-Bellas , Sonia Eiras , José Ramón González-Juanatey
Background and aims
Combined therapy, sodium-glucose cotransporter 2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP1ra) reduce all-cause mortality in patients with diabetes. We aimed to analyse the differential behaviour of combined therapy between women and men regarding all-cause mortality.
Methods and results
This is a retrospective observational cohort study. Using “Big data” according to electronic medical records in the Santiago-Barbanza health area, which covers 450,000 patients. Out of 15,118 patients, 41 % were women. The median follow-up was 33 months. Women were older (71 [62–78] vs. 67 [59–75], p: <0.001) and with a higher incidence of obesity (53 % vs. 41 %, p: <0.001), meanwhile, men presented more coronary artery disease (CAD) (19 % vs. 9 %, p: <0.001). The multinomial propensity score and multivariate Cox regression were used for statistical analysis. All-cause mortality was compared between combined vs. monotherapy in women or men. Men had a higher risk of all-cause mortality than women in this population (HR [95 % CI] 1.50 [1.28–1.75]). Combined regarding monotherapy (GLP1ra (HR [95 % CI] 0.19 [0.14–0.27]), or SGLT2i (HR [95 % CI] 0.30 [0.23–0.40]), and treatment duration (HR [95 % CI] 0.95 [0.94–0.96] were associated with lower risk of all-cause mortality; with higher benefit in women (GLP1ra (HR [95 % CI] 0.14 [0.08–0.27]), or SGLT2i (HR [95 % CI] 0.18 [0.11–0.30]) regarding men (HR [95 % CI] 0.25 [0.16–0.40] for GLP1ra, and HR [95 % CI] 0.41 [0.29–0.58] for SGLT2i).
Conclusions
Combined therapy vs. monotherapy was associated with a lower risk of all-cause mortality in patients regardless of sex. Nevertheless, a higher benefit was observed in women regarding men.
{"title":"Combined SGLT2i and GLP1ra therapy reduces all-cause mortality in people with diabetes, with greater benefit in women","authors":"David Garcia-Vega , Sergio Cinza-Sanjurjo , Carlos Tilves-Bellas , Sonia Eiras , José Ramón González-Juanatey","doi":"10.1016/j.numecd.2025.104483","DOIUrl":"10.1016/j.numecd.2025.104483","url":null,"abstract":"<div><h3>Background and aims</h3><div>Combined therapy, sodium-glucose cotransporter 2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP1ra) reduce all-cause mortality in patients with diabetes. We aimed to analyse the differential behaviour of combined therapy between women and men regarding all-cause mortality.</div></div><div><h3>Methods and results</h3><div>This is a retrospective observational cohort study. Using “Big data” according to electronic medical records in the Santiago-Barbanza health area, which covers 450,000 patients. Out of 15,118 patients, 41 % were women. The median follow-up was 33 months. Women were older (71 [62–78] vs. 67 [59–75], p: <0.001) and with a higher incidence of obesity (53 % vs. 41 %, p: <0.001), meanwhile, men presented more coronary artery disease (CAD) (19 % vs. 9 %, p: <0.001). The multinomial propensity score and multivariate Cox regression were used for statistical analysis. All-cause mortality was compared between combined <em>vs.</em> monotherapy in women or men. Men had a higher risk of all-cause mortality than women in this population (HR [95 % CI] 1.50 [1.28–1.75]). Combined regarding monotherapy (GLP1ra (HR [95 % CI] 0.19 [0.14–0.27]), or SGLT2i (HR [95 % CI] 0.30 [0.23–0.40]), and treatment duration (HR [95 % CI] 0.95 [0.94–0.96] were associated with lower risk of all-cause mortality; with higher benefit in women (GLP1ra (HR [95 % CI] 0.14 [0.08–0.27]), or SGLT2i (HR [95 % CI] 0.18 [0.11–0.30]) regarding men (HR [95 % CI] 0.25 [0.16–0.40] for GLP1ra, and HR [95 % CI] 0.41 [0.29–0.58] for SGLT2i).</div></div><div><h3>Conclusions</h3><div>Combined therapy <em>vs.</em> monotherapy was associated with a lower risk of all-cause mortality in patients regardless of sex. Nevertheless, a higher benefit was observed in women regarding men.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104483"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-13DOI: 10.1016/j.numecd.2025.104522
Mary M. Barker , Tommy Slater , Melanie J. Davies , Jack A. Sargeant , Jonathan Goldney , Emma G. Wilmot , Shivani Misra , Juliana C.N. Chan , Edward W. Gregg , Sharmin Shabnam , Kamlesh Khunti , Francesco Zaccardi
Background and aims
We aimed to investigate associations between age at diagnosis of type 2 diabetes and the relative and absolute risk of four common comorbidities: obesity, hypertension, depression, and anxiety.
Methods and results
We used primary and secondary care data from England to conduct a matched cross-sectional study of individuals aged 16–50 years (N = 108,061 with a new diagnosis of type 2 diabetes; 829,946 without type 2 diabetes). Morbidity risk was estimated using multivariable generalised linear models. Adjusted risk ratios (RRs) indicated a higher risk of all studied comorbidities in individuals with vs without type 2 diabetes at all diagnostic ages, with RRs progressively decreasing with older age at diagnosis (from 13.8 at 16–27 years to 5.7 at 48–50 years, for obesity; from 28.9 to 3.2, for hypertension; from 4.4 to 2.5, for depression; and from 4.3 to 2.2, for anxiety). The estimated total number of morbidities among individuals aged 16 years with vs without type 2 diabetes were 85.2 (95 % CI: 83.3–87.0) and 7.1 (95 % CI: 6.9–7.3) per 100 individuals, respectively. Corresponding estimates at 50 years of age were 92.0 (91.3–92.8) and 24.8 (24.6–25.0).
Conclusion
The substantially higher burden of MLTCs in young individuals with vs without type 2 diabetes emphasises the need for multidisciplinary patient care and management in individuals diagnosed with type 2 diabetes in early adulthood.
{"title":"Age at type 2 diabetes diagnosis and prevalence of obesity, hypertension, anxiety, and depression: a retrospective observational study","authors":"Mary M. Barker , Tommy Slater , Melanie J. Davies , Jack A. Sargeant , Jonathan Goldney , Emma G. Wilmot , Shivani Misra , Juliana C.N. Chan , Edward W. Gregg , Sharmin Shabnam , Kamlesh Khunti , Francesco Zaccardi","doi":"10.1016/j.numecd.2025.104522","DOIUrl":"10.1016/j.numecd.2025.104522","url":null,"abstract":"<div><h3>Background and aims</h3><div>We aimed to investigate associations between age at diagnosis of type 2 diabetes and the relative and absolute risk of four common comorbidities: obesity, hypertension, depression, and anxiety.</div></div><div><h3>Methods and results</h3><div>We used primary and secondary care data from England to conduct a matched cross-sectional study of individuals aged 16–50 years (N = 108,061 with a new diagnosis of type 2 diabetes; 829,946 without type 2 diabetes). Morbidity risk was estimated using multivariable generalised linear models. Adjusted risk ratios (RRs) indicated a higher risk of all studied comorbidities in individuals with vs without type 2 diabetes at all diagnostic ages, with RRs progressively decreasing with older age at diagnosis (from 13.8 at 16–27 years to 5.7 at 48–50 years, for obesity; from 28.9 to 3.2, for hypertension; from 4.4 to 2.5, for depression; and from 4.3 to 2.2, for anxiety). The estimated total number of morbidities among individuals aged 16 years with vs without type 2 diabetes were 85.2 (95 % CI: 83.3–87.0) and 7.1 (95 % CI: 6.9–7.3) per 100 individuals, respectively. Corresponding estimates at 50 years of age were 92.0 (91.3–92.8) and 24.8 (24.6–25.0).</div></div><div><h3>Conclusion</h3><div>The substantially higher burden of MLTCs in young individuals with vs without type 2 diabetes emphasises the need for multidisciplinary patient care and management in individuals diagnosed with type 2 diabetes in early adulthood.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104522"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To critically evaluate the 2025–2030 Dietary Guidelines for Americans (DGA), a key policy instrument shaping dietary advice in United States and influencing food production, healthcare, and global nutrition policy.
Data synthesis
Overall, the DGA remain consistent with previous documents for the recommended consumption of several food groups and limits for saturated fat, added sugars, and sodium. A welcome innovation is the strong emphasis on limiting ultra-processed foods (UPFs) and sugar-sweetened beverages, supported by their association with obesity, type 2 diabetes, and cardiovascular disease. However, several aspects of the Guidelines raise substantial concern. Most prominently, the recommendation to increase protein intake—largely from animal sources—appears unjustified, as it already exceeds requirements in economically developed populations. Moreover, it disregards long-standing evidence on increased cardiometabolic and cancer risk associated with high consumption of red and processed meat. Conversely, the scientific literature strongly supports plant-based dietary patterns, particularly the Mediterranean Diet, for health promotion; this diet has been shown to significantly reduce cardiovascular disease and type 2 diabetes incidence in randomized controlled trials.
Further scientific inconsistencies include presenting foods rich in saturated fats (butter and beef tallow) as interchangeable with healthier fat sources (olive and seed oils), and proposing an unsubstantiated new food pyramid that downplays cereal consumption, including whole grains, in favor of animal foods. Finally, the DGA completely ignore the environmental impact of dietary choices, despite their 30% contribution to global greenhouse gas emission.
Conclusions
Taken together, these Guidelines have more weaknesses than gains compared with those from Scientific Societies and WHO.
{"title":"A critical evaluation of the 2025–2030 Dietary Guidelines for Americans","authors":"Annalisa Giosuè, Marilena Vitale, Gabriele Riccardi","doi":"10.1016/j.numecd.2026.104614","DOIUrl":"10.1016/j.numecd.2026.104614","url":null,"abstract":"<div><h3>Aims</h3><div>To critically evaluate the 2025–2030 Dietary Guidelines for Americans (DGA), a key policy instrument shaping dietary advice in United States and influencing food production, healthcare, and global nutrition policy.</div></div><div><h3>Data synthesis</h3><div>Overall, the DGA remain consistent with previous documents for the recommended consumption of several food groups and limits for saturated fat, added sugars, and sodium. A welcome innovation is the strong emphasis on limiting ultra-processed foods (UPFs) and sugar-sweetened beverages, supported by their association with obesity, type 2 diabetes, and cardiovascular disease. However, several aspects of the Guidelines raise substantial concern. Most prominently, the recommendation to increase protein intake—largely from animal sources—appears unjustified, as it already exceeds requirements in economically developed populations. Moreover, it disregards long-standing evidence on increased cardiometabolic and cancer risk associated with high consumption of red and processed meat. Conversely, the scientific literature strongly supports plant-based dietary patterns, particularly the Mediterranean Diet, for health promotion; this diet has been shown to significantly reduce cardiovascular disease and type 2 diabetes incidence in randomized controlled trials.</div><div>Further scientific inconsistencies include presenting foods rich in saturated fats (butter and beef tallow) as interchangeable with healthier fat sources (olive and seed oils), and proposing an unsubstantiated new food pyramid that downplays cereal consumption, including whole grains, in favor of animal foods. Finally, the DGA completely ignore the environmental impact of dietary choices, despite their 30% contribution to global greenhouse gas emission.</div></div><div><h3>Conclusions</h3><div>Taken together, these Guidelines have more weaknesses than gains compared with those from Scientific Societies and WHO.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104614"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-03DOI: 10.1016/j.numecd.2025.104477
Yixiu Chen , Junyan Sun , Zhihui Liu , Renjie Fu , Yutong Wu , Haiyan Zhao , Liming Lin , Xiaohong Zhao , Chenrui Zhu , Chunyu Ruan , Changhao Zu , Kai Cui , Shuohua Chen , Hongmin Liu , Yuntao Wu
Background and aim
Considering that using systolic blood pressure or heart rate alone cannot comprehensively reflect cardiac workload, we employed the rate-pressure product (RPP) as a risk marker to assess the risks of cardiovascular diseases (CVDs) and all-cause mortality. Furthermore, given that blood pressure and heart rate fluctuations persist throughout life, therefore this study investigated whether lower levels of RPP variability are associated with lower risks of CVDs and all-cause mortality.
Methods and results
We analyzed data from 49,792 participants in the Kailuan Study, a prospective cohort of Chinese adults who underwent three consecutive health examinations between 2006 and 2010. RPP variability was calculated using systolic blood pressure and heart rate data, and participants were categorized into tertiles, with the highest tertile serving as the reference. Cox proportional hazards models were used to evaluate associations between RPP variability and the risks of CVDs and all-cause mortality, with additional interaction analyses by age, sex, and average RPP level. Compared to the highest tertile, participants in the second and first tertiles exhibited significantly lower risks of CVDs (hazard ratios [HRs]: 0.924 [95 % CIs: 0.856–0.997] and 0.875 [0.806–0.950], respectively; P < 0.01) and all-cause mortality (HRs: 0.882 [0.822–0.947] and 0.821 [0.760–0.866], respectively; P < 0.01). Subgroup analysis revealed a significant interaction with age and average RPP level. Age and average RPP level modified the association between RPP variability and CVDs risk, suggesting greater cardiovascular benefits of stable RPP profiles in younger individuals and those with lower baseline cardiac workload.
Conclusion
Long-term lower RPP variability was independently associated with reduced risks of cardiovascular disease and all-cause mortality, regardless of baseline RPP levels. The association was more pronounced in younger individuals and those with lower average RPP, suggesting potential benefit from targeting RPP variability in early cardiovascular prevention strategies.
{"title":"Impact of rate-pressure product variability on new-onset cardiovascular disease and all-cause mortality: A prospective cohort study","authors":"Yixiu Chen , Junyan Sun , Zhihui Liu , Renjie Fu , Yutong Wu , Haiyan Zhao , Liming Lin , Xiaohong Zhao , Chenrui Zhu , Chunyu Ruan , Changhao Zu , Kai Cui , Shuohua Chen , Hongmin Liu , Yuntao Wu","doi":"10.1016/j.numecd.2025.104477","DOIUrl":"10.1016/j.numecd.2025.104477","url":null,"abstract":"<div><h3>Background and aim</h3><div>Considering that using systolic blood pressure or heart rate alone cannot comprehensively reflect cardiac workload, we employed the rate-pressure product (RPP) as a risk marker to assess the risks of cardiovascular diseases (CVDs) and all-cause mortality. Furthermore, given that blood pressure and heart rate fluctuations persist throughout life, therefore this study investigated whether lower levels of RPP variability are associated with lower risks of CVDs and all-cause mortality.</div></div><div><h3>Methods and results</h3><div>We analyzed data from 49,792 participants in the Kailuan Study, a prospective cohort of Chinese adults who underwent three consecutive health examinations between 2006 and 2010. RPP variability was calculated using systolic blood pressure and heart rate data, and participants were categorized into tertiles, with the highest tertile serving as the reference. Cox proportional hazards models were used to evaluate associations between RPP variability and the risks of CVDs and all-cause mortality, with additional interaction analyses by age, sex, and average RPP level. Compared to the highest tertile, participants in the second and first tertiles exhibited significantly lower risks of CVDs (hazard ratios [HRs]: 0.924 [95 % CIs: 0.856–0.997] and 0.875 [0.806–0.950], respectively; P < 0.01) and all-cause mortality (HRs: 0.882 [0.822–0.947] and 0.821 [0.760–0.866], respectively; P < 0.01). Subgroup analysis revealed a significant interaction with age and average RPP level. Age and average RPP level modified the association between RPP variability and CVDs risk, suggesting greater cardiovascular benefits of stable RPP profiles in younger individuals and those with lower baseline cardiac workload.</div></div><div><h3>Conclusion</h3><div>Long-term lower RPP variability was independently associated with reduced risks of cardiovascular disease and all-cause mortality, regardless of baseline RPP levels. The association was more pronounced in younger individuals and those with lower average RPP, suggesting potential benefit from targeting RPP variability in early cardiovascular prevention strategies.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104477"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-13DOI: 10.1016/j.numecd.2025.104523
Mingni Yang , Hongwei Liu , Peng Wei , Haixia Fan , Zhijun Wang
Background and aim
Body roundness index (BRI), an innovative anthropometric measure assessing visceral fat, has demonstrated utility in predicting cardiometabolic risk. However, its association with stroke risk across blood-pressure strata remains unclear.
Methods and results
The sample comprised 12,316 CHARLS participants aged ≥45 years without prior stroke. The association between the BRI and incident stroke was evaluated using Cox proportional hazards models. To strengthen the validity of the findings, additional analyses were performed, including propensity score matching (PSM), subgroup analyses, and sensitivity tests. Furthermore, the discriminative capacity of BRI for predicting stroke events was assessed using receiver operating characteristic (ROC) curve analysis.
Increased stroke risk was significantly connected to a higher BRI. Following PSM, fully adjusted models indicated that a unit rise in log (BRI) was tied to a 19 % increase in stroke risk (HR = 1.79, 95 % CI: 1.37–2.34, P < 0.001). After stratification by blood pressure status, the association between BRI and stroke risk was most pronounced among individuals with prehypertension (HR = 2.60, 95 %CI: 1.49–4.54; P < 0.001) and those with hypertension (HR = 1.65, 95 %CI: 1.17–2.33; P = 0.004). By contrast, among participants with normal blood pressure (NBP), no statistically significant association was observed following PSM. The reliability of the findings was supported by subgroup and sensitivity analyses. The ROC analysis demonstrated that the BRI had moderate predictive accuracy for stroke, notably in individuals with NBP, with an area under the curve of 0.672.
Conclusions
Elevated BRI is independently associated with a greater risk of stroke, particularly in individuals with prehypertension or hypertension.
{"title":"Association between body roundness index and incident stroke with different blood pressure status: A retrospective propensity score matched analysis of the CHARLS study","authors":"Mingni Yang , Hongwei Liu , Peng Wei , Haixia Fan , Zhijun Wang","doi":"10.1016/j.numecd.2025.104523","DOIUrl":"10.1016/j.numecd.2025.104523","url":null,"abstract":"<div><h3>Background and aim</h3><div>Body roundness index (BRI), an innovative anthropometric measure assessing visceral fat, has demonstrated utility in predicting cardiometabolic risk. However, its association with stroke risk across blood-pressure strata remains unclear.</div></div><div><h3>Methods and results</h3><div>The sample comprised 12,316 CHARLS participants aged ≥45 years without prior stroke. The association between the BRI and incident stroke was evaluated using Cox proportional hazards models. To strengthen the validity of the findings, additional analyses were performed, including propensity score matching (PSM), subgroup analyses, and sensitivity tests. Furthermore, the discriminative capacity of BRI for predicting stroke events was assessed using receiver operating characteristic (ROC) curve analysis.</div><div>Increased stroke risk was significantly connected to a higher BRI. Following PSM, fully adjusted models indicated that a unit rise in log (BRI) was tied to a 19 % increase in stroke risk (HR = 1.79, 95 % CI: 1.37–2.34, P < 0.001). After stratification by blood pressure status, the association between BRI and stroke risk was most pronounced among individuals with prehypertension (HR = 2.60, 95 %CI: 1.49–4.54; P < 0.001) and those with hypertension (HR = 1.65, 95 %CI: 1.17–2.33; P = 0.004). By contrast, among participants with normal blood pressure (NBP), no statistically significant association was observed following PSM. The reliability of the findings was supported by subgroup and sensitivity analyses. The ROC analysis demonstrated that the BRI had moderate predictive accuracy for stroke, notably in individuals with NBP, with an area under the curve of 0.672.</div></div><div><h3>Conclusions</h3><div>Elevated BRI is independently associated with a greater risk of stroke, particularly in individuals with prehypertension or hypertension.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104523"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号